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THE  LIBRARY 

OF 

THE  UNIVERSITY 

OF  CALIFORNIA 

LOS  ANGELES 

GIFT  OF 


SAN  FRANCISCO 
COUNTY  MEDICAL  SOCIETY 


THE   TREATMENT    OF    HAY   FEVER 


THE    TREATMENT 
OF   HAY   FEVER 

BY  ROSIN-WEED,  ICHTHYOL  AND  FARADIC 

ELECTRICITY,  WITH  A  DISCUSSION  OF  THE  OLD 

THEORY   OF   GOUT   AND  THE    NEW 

THEORY  OF  ANAPHYLAXIS 

BY 

GEORGE    FREDERICK   LAIDLAW,    M.D. 

Consulting  Physician  to  Yonkers  Homoeopathic  Hospital; 
to  St.   Mary's  Hospital,   Passaic;     and  to  the  Ann 
Mary    Memorial    Hospital,  Spring   Lake,  New 
Jersey;    Consulting    Physician  to   Cum- 
berland Street  Hospital,  Brooklyn, 
Department  of  Public  Charities 

Formerly  Professor  of  Practice  of  Medicine  in  the  New  York 
Homoeopathic  Medical  College;  formerly  Visiting  Phy- 
sician to  Flower  Hospital;  to  Hahnemann  Hos- 
pital and  to  the  Metropolitan  Hospital, 
Blackwells  Island,  Department  of 
Public  Charities,  New  York 


BOERICKE  &  RUNYON 
NEW  YORK 

1917 


COPYRIGHT,  191  7,  BY 
BOERICKE  &  KUNYON 


PREFACE 


The  essentials  of  this  book,  rosin- weed, 
ichthyol,  and  faradism,  were  announced  at 
the    Baltimore    meeting    of    the    American 
Institute  of    Homoeopathy,   in  June,  191 6, 
and  pubUshed  simultaneously   in   the  New 
England  Medical  Gazette  and  in  the  Journal 
<^of  the    American   Institute    of  Homceopathy 
N  in  December,   1916.    They  were  presented 
'■also  at  the  New  York  City  branch  of   the 
. '  United    States    Hav    Fever    Association    in 
Njuly,   1 9 16;    at  the  annual  meeting  of  the 
'same  Association  at  Bethlehem,  New  Hamp- 
shire, in  August,  1916;    and  rather  widely 
printed  in  the  pubhc  press  of  New  York 
and  Boston  in  the  summer  of  1916. 
^     As  a  suggestion  to  those  who  may  wish 
Mto  follow  the    subject  of  hay  fever   in  its 
\recent    interesting   developments,   chapters 
Ifhave  been  added  on  the  old  conception  of 
/^gout,  the   new  theory  of  anaphylaxis   and 
\  treatment  by  diet,  by  pollen  extracts  and  by 
^  bacterial  vaccines. 


CONTENTS 

PAGE 

I.  The  Diagnosis 9 

II.  Rosin-weed  14 

III.    ICHTHYOL   AND    THE    PoiNT   IN    THE    NASO- 
PHARYNX THAT  Controls  the  Symptoms  17 

IV.  Menthol  and  Eucalyptol 20 

V.  The  Faradic  Current  and  Other  Forms 

of  Electricity 27 

VI.  Hay  Fever  as  Urticaria 38 

VII.  Dr.  Gueneau  de  Mussy.    Hay  Fever  as 

Urticaria  Again 44 

VIII.  Hay  Fever  as  Gout 51 

IX.  The  Uric  Acid  Theory 66 

X.  Hay  Fever  as  Anaphylaxis 76 

XI.  Immunizing  with  Pollen  Extracts 91 

XII.   The  Bacterial  Vaccines 108 

XIII.   Diet 113 

XIV.  Rosin-weed    Again.       Historical    and 

Pharmacological 123 


THE    TREATMENT    OF 
HAY    FEVER 

CHAPTER  I 
THE  DIAGNOSIS 

Under  the  name  "hay  fever"  I  include 
rose-cold  and  the  so-called  hyperaesthetic 
catarrh  or  vaso-motor  rhinitis,  all  char- 
acterized by  intense  itching  of  the  eyes, 
nose,  and  throat,  free  discharge,  sometimes 
asthma,  the  attacks  being  precipitated  by 
strong  odors,  dust,  or  pollen.  There  are 
many  forms  of  the  disease,  some  occurring  in 
May  or  June,  some  as  early  as  March,  be- 
fore the  budding  of  vegetation,  some  even 
in  the  winter;  but  the  large  majority  of 
cases  occur  in  August,  coincident  with  the 
flowering  of  late  summer  vegetation,  not- 
ably the  rag-weed  and  golden-rod.  It  is 
not  so  well  known  that  the  California  privet, 
so  mdely  used  in  hedges  and  parks,  ag- 
gravates many  patients,  especially  in  June 
and  July,  when  the  scent  of  the  flowers  is 
strong.  Others  are  irritated  instantly  by 
the  odor  of  crude  oil  that  is  spread  so  freely 


lo  The  Treatment  of  Ilay  Fever 

on  the  roads  in  summer,  by  metal-dust, 
and  by  the  cinders  of  a  railway  trip.  Some 
patients  are  sensitive  to  one  irritant,  some 
to  many  irritants.  I  knew  one  man  whose 
itching  of  the  eyes  began  in  March,  nose 
and  throat  following  in  April  and  May, 
cough  in  July  and  August,  who  was  sensi- 
tive to  each  and  all  of  these  irritants  from 
March  to  October  every  year  for  thirty 
years. 

If  we  follow  the  modern  tendency  and 
classify  the  cases  according  to  the  specific 
irritant,  we  shall  have  an  endless  number 
of  varieties  according  to  the  endless  number 
of  possible  irritants;  and  where  will  you 
classify  the  man  who  is  subject  to  them  all? 
In  the  present  state  of  our  knowledge,  it 
seems  better  to  regard  the  sensitiveness  to 
irritants  as  the  characteristic  of  these  cases 
and  to  think  of  them  as  different  forms  of 
the  same  disease.  In  most  text-books  this 
idea  is  expressed  by  the  terms  hypercesthetic 
catarrh  and  vaso-motor  rhinitis;  but  there 
are  serious  pathological  objections  to  the 
terms  catarrh  and  rhinitis.  These  objec- 
tions and  the  reasons  for  regarding  the  lesion 
as   an   angioneurotic   oedema   arc   discussed 


The  Diagnosis  1 1 

in  Chapter  VI,  on  Hay  Fever  as  Urticaria, 
to  which  the  reader  is  referred. 

An  additional  reason  for  regarding  all 
these  varieties  as  superficially  differing  forms 
of  the  same  disease  is  the  fact  that  all  of 
them  are  curable  by  the  same  methods.  I 
am  aware  of  the  danger  of  error  in  this 
argument,  the  persuasive  but  misleading 
Analogieschluss,  and  would  not  advance  it 
too  strongly.  However,  for  all  practical 
purposes  except  the  vaccine  treatment,  de- 
scribed in  Chapter  XII,  all  these  hyperaes- 
thetic  cases  may  be  regarded  as  varieties  of 
the  same  disease. 

With  a  patient  suffering  from  hay  fever,  ♦ 
as  with  a  patient  suffering  from  any  other 
disease,  the  first  thing  to  do  is  to  take  the 
history  and  make  an  examination.  Usually, 
the  nature  of  the  case  will  be  clear  from  the 
history,  but  it  is  a  mistake  to  rest  here  with- 
out looking  into  the  nose  and  throat.  In 
the  nose,  you  may  find  anything  from  a 
polyp  to  a  shoe-button,  any  of  which  may 
require  mechanical  removal  before  you  will 
make  any  progress  with  your  medicines, 
no  matter  how  well  selected.  Usually,  you  * 
will  find  nothing  but  a  swelling  of  the  mu- 


12  The  Treatment  of  II ay  Fever 

cous  membrane  of  the  turbinates  with  free 
discharge.  If  you  are  an  adept  at  exam- 
ining the  nose,  you  will  probably  search  for 
the  sensitive  areas,  touching  of  which  causes 
a  spasm  of  sneezing.  These  may  be  found 
an>^vhere  in  the  nose,  but  most  commonly 
at  the  anterior  and  posterior  ends  of  the 
middle  and  inferior  turbinated  bones.  I 
apply  ichthyol  to  the  naso-pharynx  to  test 
the  sensitive  area  described  in  Chapter  III. 

What  constitutes  a  gross  lesion  requir- 
ing surgical  removal?  Competent  men  dilTer 
widely  and  the  practice  of  the  same  man 
has  dilTered  widely  at  dilTerent  stages  of 
his  career.  For  a  time  there  was  enthusias- 
tic cutting  of  septal  spurs  and  burning  of 
redundant  mucosa  and  cauterizing  of  sen- 
sitive areas.  I  think  that  the  relation  of 
the  nose  specialist  to  hay  fever  is  similar  to 
the  relation  of  the  abdominal  surgeon  to 
neurasthenics.  The  more  experienced  he 
becomes,  the  more  he  advises  letting  them 
alone  or  using  gentle  measures.  Distinct 
pol>ps  should  be  removed. 

Having  fmished  the  examination  and 
found  no  gross  lesion  requiring  surgical 
removal,    the   treatment    must   be   decided. 


The  Diagnosis  13 

The  easiest  plan  for  both  patient  and  phy- 
sician is  to  give  rosin-weed,  as  described  in 
Chapter  II. 

The  most  painful  for  the  patient  but 
often  effective  in  severe  cases  is  the 
application  of  ichthyol,  as  described  in 
Chapter  III. 

If  the  patient  is  systematic  and  will  at- 
tend to  it,  the  ichthyol  may  be  replaced  by 
the  frequent  spraying  with  menthol  and 
eucalyptol,    as    described    in    Chapter    IV. 

The  best  treatment  of  all,  but  that  which 
takes  the  most  time  of  both  patient  and 
physician,  is  the  use  of  electricity,  as  de- 
scribed in  Chapter  V. 

Consider  the  possible  importance  of  diet 
in  the  case,  as  described  in  Chapter  XIII. 

Finally,  ponder  on  the  nature  of  hay 
fever,  as  discussed  in  Chapters  VI  to  X, 
and  the  advisability  of  using  vaccines  or 
pollen  extracts,  and  you  will  have  done  your 
whole  duty  by  your  patient  and  by  your  art. 


CHAPTER  II 
ROSIN-WEED 

For  many  years  the  fluid  extract  of  rosin- 
weed  has  been  known  in  my  family  as  a 
remedy  for  rose-cold  and  hay  fever.  This 
use  of  it  was  discovered  by  my  father,  Dr. 
Alexander  H.  Laidlaw,  in  the  epizootic  days 
of  1872,  when  horses  were  dying  by  the 
thousands  all  over  the  United  States  and 
Canada.  Though  he  knew  it  first  as  a  horse 
medicine,  its  use  seems  to  be  forgotten  in 
veterinar>^  practice,  for  I  find  no  mention  of 
it  in  available  veterinary  books,  old  or  new. 

In  my  father's  practice  this  remedy  ac- 
quired considerable  fame,  and  I  still  receive 
a  letter  or  two  every  summer  from  distant 
cities  from  some  one  who  has  heard  of  the 
miraculous  medicine.  For  many  years  it 
was  his  intention  to  give  this  remedy  to 
the  world  in  proper  form,  supported  by 
competent  testimony;  but,  in  a  busy  life, 
with  many  projects  unfulfilled,  this  was 
never  done.  During  my  own  professional 
life  I  have  been  interested  in  many  things 


Rosin-Weed  1 5 

that  seemed  more  important  than  hay 
fever  and  have  not  heretofore  taken  up  the 
matter  of  pubHshing  our  experiences  with 
the  drug.  Reahzing  that  there  were  many 
hay  fever  victims  both  in  this  country  and 
in  Europe  who  might  just  as  well  be  getting 
the  rehef  that  this  drug  would  give  them  if 
they  only  knew  about  it,  and  having  no  de- 
sire to  profit  by  my  possession  of  the  secret 
of  this  remedy,  I  made  the  announcement 
last  summer,  first  to  the  American  Institute 
of  Homoeopathy  and  next  to  the  United 
States  Hay  Fever  Association.  I  announced 
it  first  to  my  old  society,  the  Institute,  be- 
lieving that  my  friends  there,  who  have 
known  me  many  years,  would  credit  my 
statements  as  made  in  good  faith  and  give 
the  drug  a  fair  trial. 

The  Dose.  Beginning  ten  days  before 
the  expected  attack,  give  ten  drops  of  the 
fluid  extract  of  rosin-weed  in  a  little  water 
four  times  daily,  after  meals  and  on  retiring. 
To  children,  give  five  drops.  If  the  symp- 
toms of  hay  fever  appear,  increase  the  dose 
to  twenty  and  even  thirty  drops  and  con- 
tinue this  dose  through  the  entire  hay  fever 
season. 


i6  The  Treatment  of  Hay  Fever 

It  is  better  to  begin  ten  days  before  the 
expected  attack,  for,  in  hay  fever,  as  in  all 
periodic  diseases,  prevention  is  better  than 
cure,  requires  smaller  doses,  and  is  more 
certain.  However,  few  patients  are  wise 
enough  to  anticipate  trouble.  Most  patients 
apply  for  treatment  when,  literally,  the  dis- 
ease is  in  full  blast,  and  most  of  my  obser- 
vations have  been  made  on  the  latter  class. 
In  case  the  disease  has  already  begun, 
start  with  the  same  dose,  ten  drops.  If  not 
relieved  in  three  days,  increase  the  dose  by 
five  drops  every  third  day  up  to  thirty 
drops.  If  the  symptoms  should  be  relieved 
by  the  smaller  dose,  it  is  unnecessarj-  to 
increase  it. 

Cure  or  Palliation?  In  regard  to  the 
permanence  of  the  cure,  most  patients  re- 
quire it  for  several  seasons.  Some  need  it 
ever>'  season  for  many  years.  A  few  are 
permanently  cured  in  one  season. 

For  further  information  about  the  plant, 
rosin  weed,  its  preparation  and  use  in  medi- 
cine, the  reader  is  referred  to  Chapter  XIV 


CHAPTER    III 

ICHTHYOL  AND  THE  POINT  IN   THE  NASO- 
PHARYNX  THAT  CONTROLS  THE 
SYMPTOMS 

While  the  use  of  rosin-weed  was  discov- 
ered by  my  father,  the  value  of  ichthyol 
in  the  treatment  of  hay  fever  and  the  point 
in  the  naso-pharynx  that  controls  the  symp- 
toms are  discoveries  of  my  own  or,  at  least, 
I  fondly  think  so.  In  current  medical  htera- 
ture,  I  find  no  reference  to  it.  In  Merck's 
History  and  Preparation  of  Ichthyol,  a  sum- 
mary of  its  use  to  1 91 3,  ichthyol  is  advised 
in  hypertrophic  and  atrophic  rhinitis,  but 
hay  fever  is  not  mentioned.  Reference  to 
recent  books,  as  Coakley,  Ballenger,  Ivins, 
Bosworth,  Kyle,  Grayson,  show  no  knowl- 
edge of  the  use  of  ichthyol  in  hay  fever  nor 
of  the  spot  in  the  naso-pharynx  that  controls 
the  symptoms. 

The  point  of  the  matter  is  this.  In  hay 
fever,  the  itching  and  redness  of  the  eyes, 
nose,  and  throat  are  controlled  from  a  sen- 
sitive   point    in    the    naso-pharynx.    Local 


1 8  The  Treatment  of  Ray  Fever 

applications  to  this  point  will  relieve  almost 
instantly  not  only  the  itching  of  the  throat 
but  also  the  itching  of  the  eyes  and  nose 
and  all  symptoms  of  the  disease.  In  some 
cases  such  reHef  carried  out  for  several 
seasons  makes  permanent  cures. 

My  knowledge  of  it  came  about  in  this  wise. 
At  about  the  age  of  sixteen  I  developed  a 
rose-cold  that  began  in  June  and  extended 
into  September.  A  few  years  later  it  began 
in  April  and  lasted  until  October.  By  one 
of  those  ironical  tricks  that  fate  plays  on 
the  great  ones  of  the  earth,  rosin-weed,  the 
family  remedy  that  cured  ever}'body  else, 
gave  me  only  partial  relief.  It  is  unneces- 
sar>'  to  follow  in  detail  the  various  experi- 
ments made.  This  was  long  before  the 
days  of  Dunbar's  pollantin,  Holbrook  Curtis' 
ambrosia,  adrenalin,  and  the  modern  vac- 
cines. I  did  not  think  cocaine  a  safe  drug 
and  never  used  it,  preferring  the  hay  fever  to 
the  cocaine  habit.  About  this  time  ichthyol 
was  introduced  by  Merck  for  the  treatment 
of  catarrh  of  all  mucous  membranes  and  I 
found  that  ichthyol,  used  in  a  certain  man- 
ner, relieved  the  symptoms  completely.  On 
•    swabbing  the  naso-pharynx  with  pure  ich- 


Ichthyol  19 

thyol,  there  was  a  severe  burning  sensation 
for  a  minute  or  so,  but,  when  the  burning 
subsided,  there  was  great  rehef,  not  only  of 
the  itching  throat  but  also  of  the  itching  of 
the  eyes  and  nose.  That  is,  in  the  custom- 
ary swabbing  of  the  naso-pharynx,  we  touch 
a  point  that  controls  the  whole  group  of 
symptoms  of  the  eyes,  nose,  and  throat. 

In  those  days  the  laryngeal  and  pharyn- 
geal tonsils  were  very  much  to  the  fore  in 
medical  discussions,  and  at  first  I  thought 
that  this  point  was  probably  the  pharyn- 
geal tonsil  of  Luschka.  However,  judging 
from  the  location  of  the  most  severe  burn- 
ing, the  controlling  point  is  rather  on  the 
upper  surface  of  the  soft  palate.  The  exact 
location  of  this  point  is  not  of  practical  im- 
portance. If  you  swab  each  side  of  the 
naso-pharynx  with  plenty  of  ichthyol,  the  re- 
flex contraction  of  the  pharynx  while  the 
swab  is  in  it  will  spread  the  ichthyol  over 
the  right  territory. 


CHAPTER   IV 
MENTHOL  AND  EUCALYPTOL 

The  ichthyol  treatment  described  in  the 
last  Chapter  is  very  effective,  but  it  burns 
severely  for  a  few  minutes  and,  for  this 
reason,  some  patients  will  not  endure  it. 
With  children,  it  is  impossible.  Another 
disadvantage  to  the  patient  and,  sometimes, 
to  the  doctor,  too,  is  that  it  requires  the 
patient  to  come  to  the  doctor  every  day  for 
the  appHcation,  though  Dr.  Hollister  tells 
me  that  he  had  one  patient  who  learned  to 
apply  the  ichthyol  to  her  own  naso-pharynx 
and,  what  is  more  wonderful  still,  kept  up 
the  treatment  long  enough  to  get  well.  In 
recent  years  I  have  hit  on  a  treatment  that 
is  more  comfortable  than  ichthyol  and  in 
many  cases  equally  effective,  though  a  little 
slower  in  giving  relief.  It  can  be  carried 
out  by  the  patient  with  little  trouble  and 
requires  no  skill  in  handling  nasal  swabs, 
an  important  matter  with  nervous  patients 
and  children. 


Menthol  and  Eucalyptol  21 

I  have  found  that  the  ordinary  solution 
of  menthol  and  eucalyptol  and  thymol  in 
liquid  albolene  will  reUeve  hay  fever  if 
applied  to  a  certain  spot  a  certain  number  of 
times  a  day.  At  this  point  I  can  see  the 
reader's  face  assuming  an  expression  of 
pained  surprise.  What  is  there  wonderful 
about  that?  Is  there  not  a  bottle  of  this 
solution  on  the  table  of  every  doctor  in  the 
country  and  does  not  every  modern  text- 
book on  the  Nose  and  Throat  advise  inhal- 
ing vapor  of  such  a  solution  to  relieve  hay 
fever?  True.  Note  that  I  did  not  say  that 
simply  spraying  this  solution  in  the  nose 
and  throat  will  cure  hay  fever.  I  said  that 
it  must  be  applied  to  a  certain  spot  a  certain 
number  of  times  a  day.  It  is  a  case  of  the 
technique  being  more  important  than  the 
remedy;  for  I  have  no  doubt  that  there 
are  other  medicines  than  ichthyol  and  men- 
thol that  will  relieve  if  put  on  the  right  spot. 
The  reason  that  every  doctor  has  not  dis- 
covered for  himself  the  full  value  of  this 
commonly  used  solution  is  that  he  did  not 
put  it  on  the  right  spot  and  he  did  not  use 
it  often  enough. 


22  The  Treatment  of  Hay  Fever 

The  Right  Spot,  as  related  in  the  chapter 
on  Ichthyol,  is  either  the  vault  of  the 
])har\'nx  or  the  upper  surface  of  the  soft 
palate. 

Frequency.  Once  or  twice  a  day  is  in- 
significant. It  must  be  used  every  hour 
or  oftener  when  the  symptoms  are  acute. 
Here  I  borrow  an  idea  from  the  dermatolo- 
gist who  learned  long  ago  from  Unna  that 
when  an  ointment  rubbed  on  twice  a  day 
fails  to  cure  an  eczema,  it  may  be  cured  by 
keeping  the  same  ointment  constantly  ap- 
plied to  the  part,  day  and  night.  The  naso- 
pharynx of  the  hay  fever  patient  requires 
the  same  continual  application  of  the  cure 
and  we  come  as  near  as  possible  to  a  con- 
tinual appHcation  by  applying  the  solution 
every  hour  or  two. 

Such  frequent  applications  are  imprac- 
ticable as  office  treatments,  but  must  be 
carried  on  at  home  or  at  business  by  the 
patient  or  a  member  of  the  family.  If  an 
expert  hand  is  available  to  spray  the  naso- 
phar>'nx,  the  tip  of  the  atomizer  should  be 
pointed  forward  so  that  the  spray  is  directed 
into  the  posterior  nares  and  the  posterior 
surface   of  the  soft  palate  as   well   as    the 


Menthol  and  Eucalyptol  23 

vault  of  the  pharynx.  An  adroit  patient 
may  learn  to  do  this,  but  even  an  adroit 
patient,  unfamiliar  with  the  anatomy  of 
the  throat,  may  spray  only  the  front  of  the 
palate  and  fail  to  get  the  solution  correctly 
applied.  To  avoid  these  mistakes  and  in- 
sure the  oil  getting  on  the  right  spot,  the 
patient  should  be  taught  the  following  simple 
technique. 

Method  of  Application.  Taking  an  or- 
dinary atomizer  full  of  the  oil,  the  patient 
Hes  on  the  back  with  the  head  low  or  on  one 
flat  pillow.  He  must  be  able  to  breathe 
freely  through  the  nostril  to  be  treated. 
Usually,  one  side  of  the  nose  is  free  and  he 
begins  with  that  side,  inhahng  the  oily  spray 
freely.  He  then  remains  lying  on  the  back 
with  the  head  low  while  the  oil  runs  back- 
ward into  the  naso-pharynx,  especially  on 
the  upper  surface  of  the  soft  palate,  where 
it  burns  a  Httle  but  not  nearly  as  much  as 
ichthyol.  After  two  minutes  or  so,  the 
other  side  must  be  treated,  but  it  must  first 
be  opened  up  so  that  the  patient  can  breathe 
freely  through  it.  This  is  done  by  turning 
on  one  side  so  that  the  stuffy  side  is  upper- 
most.    In  a  few  minutes  this  side  will  open 


24  The  Treatment  of  Ilay  Fever 

up  and  the  spray  can  be  inhaled  through  it 
freely  back  into  the  throat.  To  be  thorough, 
the  patient  treats  each  side  several  times. 
For  the  first  few  days  the  treatment  should 
be  carried  out  every  hour  or  so.  After  a 
few  days  or  a  week  mild  cases  get  perfect 
relief  and  even  severe  cases  may  drop  to 
four  treatments  daily.  Such  a  method  is 
far  safer  than  cocaine,  which  should  never 
be  put  in  the  hands  of  the  patient  for  any 
purpose  whatever. 

For  obstinate  cases  ichthyol  remains  the 
most  effective  of  the  local  applications. 
With  those  adults  who  can  learn  to  spray 
the  naso-phar>^nx  and  who  are  heroic  enough 
to  bear  the  sharp  burning  for  a  few  minutes 
for  the  sake  of  ultimate  relief,  I  mix  one- 
tenth  ichthyol  with  the  albolene  spray  solu- 
tion. Ichthyol  leaves  the  throat  raw  and 
uncomfortable  for  a  few  minutes.  For  this 
reason  it  should  not  be  used  as  frequently 
as  the  albolene  solution. 

Ichthyol  does  not  mix  well  with  the  al- 
bolene, but  precipitates  quickly.  As  it  does 
not  mix  readily  by  shaking,  the  mixture 
must  be  stirred  before  using.  The  manu- 
facturers,   McKesson    and    Robbins,    were 


Menthol  and  Eucalyptol  25 

good  enough  to  experiment  in  their  labora- 
tory with  mixtures  of  ichthyol  and  albolene. 
They  report  that  they  were  unable  to  make 
a  satisfactory  combination  and  that  "the 
only  way  to  get  a  permanent  mixture  of  the 
two  would  be  by  a  process  of  emulsion, 
which  would  be  too  thick  for  spraying 
purposes." 

It  may  be  objected  that  my  newly  dis- 
covered point  in  the  naso-pharynx  is  merely 
the  posterior  end  of  the  inferior  turbinated 
bone,  as  described  by  Mackenzie  and  Sajous 
and  others  long  ago,  and  that  the  spraying 
of  the  nasal  passages  simply  benumbs  the 
sensitive  areas,  anterior,  middle,  and  pos- 
terior, that  are  well  known  to  rhinologists. 
This  may  be  so.  At  any  rate,  the  method 
just  described  makes  possible  a  treatment  of 
these  areas  in  every  case,  though  far  from 
skilled  assistance.  The  treatment  by  cautery 
must  always  remain  a  treatment  by  the 
skilled  specialist  in  selected  cases.  Even 
if  my  sensitive  spot  in  the  pharynx  is 
nothing  new,  this  method  will  at  least  place 
in  the  hands  of  thousands  of  hay  fever 
sufferers  a  simple  method  of  relief,  which 
thought  there  is  more  satisfaction  than  in 


26  The  Treatment  of  Hay  Fever 

being  reputed   the  discoverer  of  the  resur- 
rection bone  itself.  ^ 

*  Throughout  the  middle  ages,  there  was  a  firm  be- 
lief in  the  existence  in  the  human  body  of  an  inde- 
structible bone  which  was  thought  to  be  the  necessary- 
nucleus  of  the  resurrection  body.  With  the  revival  of 
dissection  and  the  study  of  anatomy  in  the  sixteenth 
century,  many  anatomists  searched  for  it  eagerly  but 
it  was  never  found. 


CHAPTER  V 

THE  FARADIC  CURRENT  AND  OTHER  FORMS 
OF  ELECTRICITY 

The  distinguished  dermatologist,  Dr.  Dun- 
can Bulkley,  used  to  argue  that  lupus  ery- 
thematosus was  a  neurosis  because  he  could 
cure  it  with  phosphorus  and  thought  so 
highly  of  this  tour  d'esprit  that  he  made  it 
the  subject  of  a  Presidential  Address. 

In  the  same  way  I  might  argue  for  my 
favorite  theory  that  hay  fever  is  a  neurosis, 
an  angioneurotic  oedema,  because  it  is 
curable  by  electricity;  or  that  electricity 
cures  hay  fever  because  it  is  a  neurosis. 
These  are  examples  of  reasoning  by  analogy, 
found  so  frequently  in  medical  writings,  so 
plausible  and  so  perilous,  leading  more  often 
to  error  than  to  truth.  So  I  will  not  argue 
the  matter  at  all,  but  simply  state  the  result 
of  my  observation  that  faradic  electricity 
cures  hay-fever.  This  electric  treatment 
takes  time  and  trouble,  but  if  both  physician 
and  patient  are  willing  to  take  that  time 


28  The  Treatment  of  Hay  Fa'er 

and  trouble,  more  permanent  cures  may  be 
secured  than  by  any  other  treatment  known 
to  me. 

The  use  of  electricity  to  cure  hay  fever  is 
one  of  those  bits  of  therapeutic  gold  that 
lie  long  hidden  in  medical  literature,  are 
found  for  a  moment,  and  quickly  lost  again. 
Back  in  1875  Beard  and  Rockwell  si)eak 
of  two  cases,  one  cured  and  the  other  re- 
lieved by  descending  galvanism.  In  1871, 
Neftel  relieved  a  case  of  hay  asthma  by 
galvanizing  the  vagus;  but  recent  books 
know  nothing  of  it.  MoncU,  Bigelow, 
Massey,  and  Bartholow  know  electricity 
about  the  nose  only  as  a  cautery.  Tousey's 
big  book  suggests  the  local  application  of 
the  high  frequency  current  in  hay  fever, 
of  which  more  anon  at  the  end  of  this 
Chapter. 

It  was  from  none  of  these  that  I  stumbled 
on  the  fact  that  faradic  electricity  would 
cure  hay  fever.  In  1894  there  appeared  in 
New  York  a  patriarchal  old  gentleman 
with  a  queer  idea  that  he  could  cure  pneu- 
monia, tuberculosis  of  the  lungs,  and  asthma 
by  manipulation.  He  was  Dr.  Orrick  Met- 
calfe, of  Natchez,  Mississippi,  a  brother  of 


Forms  of  Electricity  29 

Dr.  John  T.  Metcalfe,  long  one  of  the  lead- 
ing physicians  of  New  York  and  Professor 
of   Medicine  in   the   College  of  Physicians 
and  Surgeons.    Dr.  Metcalfe  visited  various 
hospitals,  trying  to  interest  physicians  in  his 
method,  demonstrating  it  freely  to  whom- 
ever would  attend.     He  had  a  hard  time 
with  the  PhiHstines,  who,  for  his  brother's 
sake,   would  receive  him  politely  in   their 
clinics,   give   him   any   number   of   charity 
patients  to  work  on,  but  seldom  take  the 
trouble  to  go  personally  and  see  what  he 
could  do.     He  remained  in  New  York  for , 
several  years,  during  which  time  I  watched 
his  work  and  was  convinced  that  the  prin- 
ciple was  sound  and  the  results  good.     He 
made  one  striking  cure  of  a  patient  of  mine, 
an  old  lady  who    for  many   years  had   a 
most  obstinate  cough  that  she  had  taken  all 
over  the  world,  to  Egypt  and  Switzerland 
and  Colorado,  without  rehef.    Dr.  Metcalfe 
treated  her  by  his  manipulation  in  the  win- 
ter of  1896,  cured  the  cough  so  thoroughly 
that   it   has   never   returned,    now    twenty 
years,  as  I  know  personally,  because  the  old 
lady  still  consults  me  for  minor  ills.      Let 
me  add  this  tribute  to  his  memory,  that 


30  The  Treatment  of  Hay  Fa^er 

there  never  lived  a  more  unselfish,  practically 
benevolent  physician  than  Orrick  Metcalfe, 
true  to  the  noblest  traditions  of  medicine, 
working  away  at  his  hobby,  not  because  it 
was  profitable,  which  it  was  not,  but  because 
he  beheved  it  to  be  true,  constantly  seeking 
with  open  mind  to  improve  his  methods  and 
to  learn  better  ways. 

In  regard  to  asthma  and  pneumonia  and 
phthisis,  his  starting  point  was  a  supposed 
stiffness  or  rigidity  or  lameness  of  the  mus- 
cles of  respiration  as  the  first  step  in  the 
chain  of  events,  and  his  effort  was  to  limber 
up  at  as  early  a  time  as  possible  this  stiff- 
ness of  the  muscles.  By  manipulating  the 
muscles  of  the  chest,  neck,  back,  and  abdo- 
men, he  would  find  certain  points  that  hurt 
or  where  the  muscles  were  plainly  tight  or 
stiff.  Continuing  the  manipulation,  he  would 
have  the  patient  take  deep  breaths  and  try 
to  cough.  Often,  when  a  certain  spot  was 
manipulated,  the  patient  would  begin  to 
cough  without  prompting.  Such  a  spot 
was  his  delight  to  find.  He  would  continue 
to  manipulate  it,  encouraging  the  patient 
to  cough  and  expectorate,  holding  that  free 
expectoration   brought   relief   to   the  lesion. 


Forms  of  Electricity  31 

In  pneumonia  the  expectoration  was  often 
bloody,  which  pleased  him  mightily.  I 
have  seen  him  thus  manipulate  a  consump- 
tive only  a  few  hours  after  a  hemorrhage 
and  encourage  him  to  expectorate,  in  such 
direct  contradiction  to  our  usual  poHcy  of 
absolute  rest  that  I  trembled  inwardly  for 
the  patient. 

The  possible  relation  between  a  muscle- 
bound  chest  and  dyspnoea  is  easily  under- 
stood, but   those   of  us  who  watched  him 
could  not  see  a  clear  connection  between 
the  muscle-bound  chest  and  pneumonia  or 
phthisis.    However,  in  some  later  paper  I 
will  return  to  this  part  of  Dr.   Metcalfe's 
work.     To  return  to  asthma.  Dr.  Metcalfe 
used  to  say  that  he  thought  there  was  some 
way  of  reHeving  the  tight  muscles  better 
than  by  manipulation  and  regretted  his  un- 
familiarity  with  electricity,  which  he  thought 
might  be  that  better  way.     I  gave  him  a 
spare    battery    that    we    had    around    the 
office,  but  the  old  dog  cannot  easily  learn 
new  tricks  and  the  old  doctor  stuck  to  what 
he  knew  and  had   reHed  on   for  so  many 
years,   his    own    fingers.     He    treated   hay 
fever  by  manipulating  the  eyes,  nose,  and 


32  The  Treatment  of  II ay  Fever 

both  the  inside  and  the  outside  of  the  throat, 
wherever  the  itching  appeared. 

About  this  time  a  patient  appHed  for 
rehef  of  attacks  of  asthma  that  were  brought 
on  by  inhahng  dust.  Every  time  he  stirred 
the  papers  on  his  desk  —  and  being  an  artist, 
his  desk  was  ahvays  dusty  —  he  had  a  disa- 
greeable attack  of  asthma.  Here  was  an 
opportunity  to  test  the  Metcalfe  theory  of 
tight  muscles.  As  I  was  much  more  familiar 
with  the  faradic  battery  than  with  mani])u- 
lation  and  it  was  more  agreeable  to  use,  I 
j)laced  one  sponge  on  the  back  of  the  neck 
and  with  the  other  twitched  the  muscles 
over  the  chest.  To  include  all  the  respi- 
ratory muscles,  I  exercised  those  of  the 
neck  and  throat,  the  abdomen  and  back,  as 
well  as  the  pectorals  and  the  muscles  about 
the  scapulae.  Until  one  stops  to  think  of  it, 
he  does  not  realize  the  extent  of  the  respira- 
tory muscles.  Almost  every  muscle  from 
the  base  of  the  skull  to  the  brim  of  the  pelvis 
is  directly  concerned  in  respiration. 

With  the  faradic  current  just  as  with  the 
manipulating  fingers,  there  are  sore  spots 
that  the  patient  describes  as  bruised.  They 
may  be  extremely  tender,  though  the  patient 


Forms  of  Electricity  33 

is  not  aware  of  them  until  you  find  them 
with  the  battery  sponge  or  the  finger.  These 
sore  spots  may  be  found  anywhere  over 
the  chest  or  abdomen,  but  are  particularly 
common  at  the  attachment  of  tendon  to 
bones,  the  joints  between  the  ribs  and  the 
costal  cartilages  and  the  joints  of  the  sternum, 
especially  the  joint  between  the  ensiform 
and  the  gladiolus.  My  idea  was  that  if 
there  were  any  stiff  or  tight  muscles  restrain- 
ing the  action  of  the  ribs,  the  faradic  exer- 
cise would  limber  them  up. 

I  treated  this  patient  twice  a  week  for 
three  months  and  had  the  satisfaction  of 
seeing  this  asthmatic  sensitiveness  entirely 
cured;  for  he  has  remained  free  from  it  ever 
since,  now  twenty  years.  This  case  lead 
me  to  try  the  current  on  hay  fever  patients, 
passing  the  current  over  the  eyes  and  nose 
and  sometimes  inside  of  the  throat,  wher- 
ever there  was  itching,  just  as  Dr.  Metcalfe 
had  done  with  his  manipulating  finger. 
If  cough  or  asthma  were  present,  I  treated 
them  as  in  the  case  of  the  artist  just  described. 

Treatment.  With  one  sponge  on  the 
nape  of  the  neck  or  between  the  scapulae, 
pass  the  other  sponge  over  the  eyes,  nose. 


34  The  Treatment  of  Hay  Fever 

and  throat  for  ten  minutes.  Use  a  gentle 
current,  just  enough  for  the  patient  to  feel 
it  but  not  strong  enough  to  cause  pain.  If 
cough  or  asthma  are  present,  twitch  the 
respirator}^  muscles  for  ten  minutes  more, 
not  forgetting  that  the  respiratory  muscles 
include  the  abdominal  muscles,  those  of 
the  whole  length  of  the  spine,  and  the 
cervical  muscles  all  around,  as  well  as  the 
pectorals  and  the  scapular  muscles. 

In  regard  to  polarity,  I  do  not  think  it 
makes  any  real  difference  which  pole  is 
used  in  each  place.  I  am  old-fashioned 
enough  to  remember  when  the  polarity  of  a 
faradic  battery  was  determined  by  holding 
two  sponges  of  equal  size,  one  in  each  hand, 
turning  the  current  on  quite  strong  and 
calling  the  stronger  one  the  negative.  In 
those  days  I  learned  to  use  this  "negative" 
pole  for  active  treatments  and  this  is  still 
my  habit,  putting  the  positive  on  the  back 
and  twitching  the  muscles  with  the  negative. 
If  this  exposition  seems  crude  to  the  modern 
electro-therapeutist,  I  can  only  say  that 
I  am  not  writing  a  treatise  on  electro- 
physics,  but  relating  the  experiences  in  actual 
practice  over  a  period  of  nearly  thirty  years. 


Forms  of  Electricity  35 

The  customs  in  which  I  was  brought  up 
are  good  enough  for  me  until  I  see  real  reason 
for  changing  them.  The  electro-therapeu- 
tist is  at  liberty  to  turn  the  sponges  around 
and  use  them  the  other  way  if  it  appeals  to 
him  as  more  fitting. 

One  of  the  most  brilliant  cures  of  hay  . 
fever  with  faradic  electricity  was  made  by 
Dr.  Thomas  P.  Birdsall,  of  PawHng,  New 
York,  about  fifteen  years  ago.  The  patient 
was  a  farmer's  daughter  of  twenty  years 
who  had  lived  all  her  life  on  a  farm  in  Put- 
nam County  and  had  suffered  many  years 
from  hay  fever.  Dr.  Birdsall  used  the  fa- 
radic current  from  a  small  portable  battery 
three  times  a  week,  while  the  patient  remained 
on  the  farm  in  the  irritating  environment,  and 
in  one  season  made  a  cure  that  has  lasted 
to  this  day. 

Other  Forms  of  Electricity.  It  is  prob- 
able that  all  forms  of  electricity  will  reUeve 
or  cure  hay  fever.  I  have  used  the  faradic 
current  because  it  was  the  most  convenient. 
It  is  still  the  most  convenient  current  for 
most  physicians.  The  old  reports  are  of 
the  galvanic.  Ballenger  recommends  the 
leucodescent  Ught.     I  have  seen  several  re- 


36  The  Treatment  of  Hay  Fever 

ports  of  the  use  of  the  high  frequency  cur- 
rent and  Tousey  devotes  a  short  paragraph 
to  it,  as  follows: 

"The  author  suggests  the  use  of  a  glass 
vacuum  electrode  insulated  by  a  double 
wall  except  at  its  extremity,  which  can  be 
applied  to  all  parts  of  the  nasal  mucosa 
but  especially  to  the  inferior  and  middle 
turbinated  bones.  ...  A  similar  application 
may  be  made  to  the  outer  surface  of  the 
nose  at  the  sides,  halfway  from  the  root  to 
the  tip."     (Second  Edition,  page  598.) 

From  my  experience  with  patients  I 
doubt  whether  many  of  them  would  su]3- 
mit  to  the  intra-nasal  spark.  A  theoretical 
objection  to  using  any  form  of  high  fre- 
quency or  diathermia  on  the  outside  of  the 
nose  is  that,  in  some  skins,  frequent  applica- 
tion of  these  currents  causes  a  permanent 
dilatation  of  the  cai)illaries  of  the  skin,  re- 
sulting in  permanent  redness.  I  tremble 
to  think  of  the  wrath  of  the  fair  lady  whom 
you  should  cure  of  the  hay  fever  by  endow- 
ing her  with  a  permanently  red  nose.  I 
know  that  these  currents  are  used  on  the 
face  freely  by  dermatologists  and  have 
often  made  a  few  applications  to  break  up  a 


Forms  of  Electricity  37 

catarrhal  cold;  but  I  have  seen  cases  enough 
of  capillary  dilatation  and  its  intractability 
to  make  me  pause  and  choose  for  the  nose 
and  face  the  surely  safe  faradic  current 
rather  than  the  more  spectacular  but  risky 
high-frequency. 


CIL\PTER  VI 
HAY  FEVER   AS   URTICARIA 

The  fundamental  error  in  all  the  literature 
on  hay  fever  is  the  teaching  that  the  lesion 
is  a  pecuHar  kind  of  catarrhal  inflammation; 
whereas  it  is  not  an  inflammation  at  all, 
catarrhal  or  any  other  kind.  The  symp- 
toms of  hay  fever  resemble  those  of  catarrhal 
inflammation,  but  the  resemblance  is  only 
superficial.  The  resemblance  is  striking  and 
must  be  so  to  have  deceived  so  many  skilled 
observers,  but  it  is  only  superficial,  never- 
theless. 

When  you  see  a  patient  with  eyes  red  and 
swollen,  overflowing  with  tears  and  mucus, 
burning  and  sensitive  to  light,  you  say  at 
once,  catarrhal  conjunctivitis.  In  the  nose 
the  sneezing,  the  discharge,  the  obstructive 
swelling  suggest  at  once  catarrhal  rhinitis. 
But  stop  a  moment.  Did  you  ever  cure  a 
catarrhal  conjunctivitis  or  rhinitis  in  three 
minutes  by  moving  the  patient  from  one 
room  to  another?  You  can  do  that  with 
hay  fever.     If  you  can  remove  the  patient 


Hay  Fever  as  Urticaria  39 

from  the  irritating  atmosphere,  the  swell- 
ing and  redness  will  subside  rapidly,  the 
discharge  cease,  and  in  five  or  ten  minutes 
you  would  scarcely  know  by  examining  the 
patient  that  there  was  anything  the  matter 
with  his  eyes  and  nose.  By  returning  him 
to  the  irritating  atmosphere  the  symptoms 
will  return  instantly.  By  removing  him 
again,  they  will  rapidly  subside.  I  have 
watched  this  many  times  in  my  own  eyes. 
It  was  in  watching  the  changes  in  my  own 
eyes  and  nose  that  I  realized  that  this  was 
no  catarrhal  inflammation  but  a  much  more 
superficial  lesion. 

Did  you  ever  see  a  catarrhal  conjunc- 
tivitis that  acted  in  this  way  or  a  cold  in  the 
head  in  which  the  patient  could  be  cured 
and  catch  a  fresh  cold  twenty  times  a  day? 
I  think  you  never  did.  A  true  inflamma- 
tion requires  time,  a  few  hours,  for  its 
development,  and  when  an  inflammatory 
exudate  oozes  into  the  meshes  of  the  tissue, 
it  requires  some  days  or  at  least  some  hours 
to  be  absorbed.  This  one  point  of  rapid 
appearance  and  rapid  disappearance  would 
forbid  our  calling  the  lesion  of  hay  fever  a 
catarrhal  inflammation. 


40  The  Treatment  of  Hay  Fever 

Next,  associate  this  rapid  appearance  and 
disappearance  with  the  chief  symptom  of 
hay  fever,  the  itching,  the  intolerable  itching, 
of  the  eyes,  nose,  and  throat,  itching  that 
ceases  at  once  on  removal  from  the  irritat- 
ing atmosphere  and  returns  instantly  when 
the  irritating  atmosphere  is  reapplied.  Turn 
to  the  skin,  the  external  mucous  membrane. 
What  is  that  disorder  of  the  skin  that  appears 
abruptly,  presents  redness,  swelling,  and 
intense  itching,  and  ceases  abruptly  after 
a  few  minutes  or  a  few  hours  according  to 
your  ability  to  get  rid  of  the  irritating 
cause,  —  that  can  be  reproduced  any  num- 
ber of  times  by  exposure  to  the  same  cause? 
Why,  hives,  of  course,  urticaria  or  angio- 
neurotic oedema.  And  a  hive  (or  urticaria 
or  angioneurotic  oedema)  is  not  an  inflam- 
mation. It  is  a  vascular  spasm,  a  spasm 
of  the  minute  vessels  that  drain  small  areas 
of  skin,  causing  a  local  stoppage  of  the  cir- 
culation in  that  small  area,  a  turgescence 
or  exudate,  the  hive.  Just  as  suddenly  as 
it  began,  the  spasm  of  the  vessels  may 
relax,  the  swollen  area  is  drained  rapidly, 
and  the  hive  disappears,  leaving  a  faint  red- 
ness.    This    is   exactly    the   case   with   hay 


Hay  Fever  as  Urticaria  41 

fever.  It  is  an  urticaria,  a  vascular  spasm. 
The  sudden  onset  in  response  to  a  specific 
irritant  and  the  sudden  disappearance  —  this 
is  no  catarrhal  inflammation  and  no  rhinitis 
or  inflammation  of  any  kind. 

Those  cases  of  hives  that  appear  quickly- 
after  chilling  the  skin  are  perfect  analogues 
of  hay  fever,  appearing  in  response  to  the 
local  irritation  of  odors  and  dust.  There 
are  cases  of  hay  fever  that  resemble  ordinary 
hives  in  being  aggravated  by  certain  foods, 
especially  strawberries,  acid  foods,  and  malt 
liquors.  This  has  a  practical  bearing  on 
treatment;  for,  in  such  cases,  simply  ex- 
cluding these  foods  from  the  diet  and  the 
administration  of  an  alkah  gives  relief. 
Again,  many  hay  fever  subjects  suffer  from 
urticaria,  as  in  the  case  reported  to  me  by 
Dr.  Rice  of  Hawaii,  in  which  the  attacks 
of  hay  fever  alternated  with  urticaria. 

Sir  Morell  Mackenzie  was  wrong  when 
he  said  that  hay  fever  "had  no  pathology 
because  it  leaves  no  permanent  structural 
lesion  behind  it."  Hay  fever  "has  a  pa- 
thology" if  urticaria  has  a  pathology,  for 
urticaria,  too,  subsides  and  leaves  no  traces. 
However,   in  this  statement,   we  recognize 


42  Tlic  Treatment  of  Hay  Feixr 

the  effort  to  state  the  difference  between 
the  evanescent  lesions  of  hay  fever  and  the 
more  persistent  lesions  of  catarrhal  inflam- 
mation; which  is  just  the  difference  between 
an  urticaria  that  comes  and  goes  in  half  an 
hour  and  an  eczema  (catarrhal  dermatitis) 
that  takes  several  days  to  develop  and  is 
attended  by  a  real  inflammatory  exudate 
that  requires  many  days  for  its  absorption. 

In  our  text-books,  our  ablest  specialists 
perpetuate  this  error  by  devising  such  names 
as  hypcrccsthetic  catarrh,  hyperccsthetic  rhini- 
tis, vaso-motor  rhinitis  —  and  then  describ- 
ing a  neurosis.  The  two  ideas  will  not 
mix.  The  very  authors  who  introduce  these 
names  feel  that  there  is  something  wrong 
with  them,  for  usually  they  take  several 
pages  to  explain  what  the  name  means.  It 
is  better  to  throw  overboard  both  the  name 
and  the  idea  of  catarrhal  inflammation  or 
rhinitis  and  start  afresh. 

Recent  workers  with  pollens  come  near 
the  truth  in  describing  hay  fever  as  an 
anaphylaxis.  Right  here  my  conception  of 
the  lesion  of  hay  fever  as  an  urticaria  flts 
into  the  picture  and  brings  us  one  step 
nearer  to  an  understanding  of  the  disease; 


Hay  Fever  as  Urticaria  43 

for  where  is  there  a  prettier  example  of 
anaphylaxis  than  those  very  hives  with 
which  long  ago  I  compared  the  lesion  of 
hay  fever? 

Since  Bostock  first  described  hay  fever 
in  1 8 16,  hundreds  of  physicians  have  looked 
at  thousands  of  patients,  but,  as  far  as  I 
can  discover,  there  was  just  one  observer 
besides  the  modest  author  of  this  book  who 
recognized  the  urticarial  nature  of  the  lesion 
of  hay  fever.  This  was  Dr.  Gueneau  de 
Mussy,  to  whom  we  will  devote  the  next 
chapter. 

The  Cause  Behind  the  Lesion.  All 
clinicians  agree  that  there  are  two  elements 
in  the  hay  fever  problem,  — first,  the  irritant; 
and  secondly,  the  abnormal  sensitiveness  of 
the  patient.  All  are  fairly  well  agreed  as 
to  the  irritants,  pollen  and  dust;  but  what 
makes  the  patient  sensitive?  This  is  stiU 
the  dark  side  of  the  subject.  Among'  the 
many  theories,  two  seem  to  deserve  further 
study  and  will  be  considered  in  the  chapters 
on  Hay  Fever  as  Gout  and  Hay  Fever  as 
Anaphylaxis. 


CHAPTER   VII 

DR.   GUENEAU   DE   MUSSY 
HAY    FEVER   AS    URTICARIA    AGAIN 

In  searching  through  the  early  literature 
of  rosin-weed,  as  related  in  Chapter  XIV 
I  noted  that  the  article  in  the  Eclectic  Medical 
Review  recommending  rosin-weed  for  asthma 
seemed  to  have  been  copied  only  in  the  south- 
ern and  western  medical  journals.  I  was 
curious  to  know  if  the  aristocratic  medical 
editors  of  the  east,  the  intimates  of  Bigelow 
and  Holmes  and  Warren,  had  deigned  to 
notice  a  drug  of  such  lowly  parentage,  dis- 
covered by  the  Indians  and  indorsed  by 
the  medical  heretics.  I  began  with  the 
stately  row  of  bound  volumes  of  the  Boston 
Medical  and  Surgical  Journal,  running  back 
to  '%o,  that  repose  on  a  dusty  back  shelf 
of  the  Librar}'  of  the  New  York  Academy 
of  Medicine.  Looking  through  the  volumes 
around  1868,  when  the  use  of  rosin-weed  in 
asthma  was  being  quoted  in  the  south  and 
west,  I  found  many  cjuaint  notes  and  com- 
ments, but  no  mention  of  rosin-weed.     To 


Dr.  Gueneau  de  Mussy  45 

any  physician  who  has  a  taste  for  the  his- 
tory of  his  art,  I  would  recommend  reading 
a  journal  of  fifty  years  ago.  So  many 
things  have  been  settled  that  those  old 
physicians  puzzled  and  fought  over  that  it 
gives  one  the  sense  of  amusement  or  lofty 
detachment  of  the  gods,  looking  down  on 
struggling,  wrigghng  humanity,  yet  know- 
ing all  the  time  how  it  would  come  out.  - 

In  those  old  books  I  noticed  abundant 
quips  and  sneers  at  homoeopathy,  now 
happily  taboo  in  the  more  courteous  journal- 
ism of  to-day.  Besides,  they  are  not  so 
funny  now.  The  doctrine  of  hke-cures-like 
and  the  small  dose  has  achieved  respecta- 
bihty.  When  armies  all  over  the  world 
are  depending  on  a  minute  dose  of  typhoid 
poison  to  prevent  and  cure  typhoid  fever, 
when  articles  appear  in  the  most  respectable 
medical  journals  advocating  doses  of  tu- 
bercuHn  so  small  that  they  have  never  been 
calculated  and  one-tenth  grain  doses  of 
calomel  instead  of  the  twenty-grain  doses 
of  our  grandfathers,  most  of  the  merry  jests 
have  lost  their  flavor  to-day.  Rather  as 
I  expected,  in  the  Boston  Journal,  I  found 
no  notice  of  the  eclectic  rosin-weed,  but   I 


46  The  Treatment  of  Hay  Fever 

found  something  better,  a  clinical  lecture 
on  hay  fever  by  a  man  after  my  own 
heart,  who,  away  back  in  1868,  had  recog- 
nized the  urticarial  nature  of  the  lesion 
in  hay  fever.  This  was  a  Clinical  Lecture 
on  Spasmodic  Coryza  or  Periodical  Asthma, 
dehvered  at  the  Hotel  Dieu,  by  Professor 
Gueneau  de  Mussy,  translated  from  the 
Gazette  des  Ilopitaux  by  W.  F.  Munroe,  M.D. 
The  lecture  runs  through  several  numbers 
of  the  Journal,  beginning  in  March,  1869, 
page  125.  It  should  be  read  by  every 
rhinologist  and  by  every  physician  who  is 
treating  hay  fever. 

When  the  chemist  Woehler,  one  afternoon 
in  1828,  tried  to  make  up  some  ammonium 
cyanate  by  mixing  ammonium  sulphate  and 
potassium  sulphate  and  found  that  he  had 
synthesized  urea,  one  of  his  colleagues  said 
that  he  was  like  Saul,  who  went  out  to  find 
his  father's  asses  and  found  a  kingdom.  I 
felt  the  same  way;  only,  in  my  case,  I  went 
out  among  the  asses  and  found  a  king. 

WTien  Solomon  made  his  despondent  re- 
mark that  there  was  nothing  new  under  the 
sun  and  that  of  the  making  of  books  there 
is  no  end,  he  must  have  been  in  his  library 


Dr.  Gueneau  de  Mussy  47 

sorting  out  his  collection  of  old  Assyrian 
bricks  and  found  that  his  favorite  thoughts 
had  been  said  already  and  said  better  by 
some  old  Hittite  scribe  a  thousand  years 
before.  So  I,  who  had  fondly  thought  my- 
self the  discoverer  of  the  urticarial  nature  of 
hay  fever  because  I  had  searched  the  books 
of  the  speciahsts  and  found  nothing  about 
it,  was  surprised  to  find  my  observation 
anticipated  by  the  Frenchman. 

Salut!  Hail  to  you  across  the  years, 
Gueneau  de  Mussy,  kindred  spirit.  It  is 
not  recorded  that  the  gray-headed  Dean 
of  a  great  university  ever  stood  you  on  a 
platform  and  hurled  Latin  adjectives  at 
you;  but  in  1868  you  had  the  sharpest  eyes 
and  clearest  mind  of  any  of  them,  M.D.'s  or 
LL.D.'s,  though  bespattered  with  all  the 
letters  of  the  alphabet. 

Of  all  the  foolish  things  that  scientific 
men  quarrel  about,  one  of  the  most  foolish 
is  the  question  of  priority  of  discovery. 
A  scientist  who  will  welcome  the  opinion  of 
another  scientist  agreeing  with  him  the  day 
after  he  announces  his  discovery  will  fight 
like  a  cat  against  evidence  that  the  same 
man  agreed  with  him  the  day  before.     It 


48  The  Treatment  oj  II ay  Fever 

seems  to  me  that  if  another  human  being 
confirms  your  work,  it  does  not  make  any 
diiTerence  whether  he  does  it  the  century 
before  or  after  your  transient  existence. 
In  fact,  you  should  be  more  pleased  to  have 
it  "confirmed"  the  century  before,  because 
then  you  will  have  a  chance  to  know  about 
it. 

Besides  recognizing  the  urticarial  nature 
of  the  lesion,  de  Mussy  sought  the  under- 
lying cause  of  hay  fever  and  thought  to 
find  it  in  the  gouty  diathesis.  He  notes  the 
occurrence  of  hay  fever  in  gouty  families, 
its  periodicity,  its  association  with  urti- 
caria, eczema,  granular  pharyngitis  and 
asthma,  all  characteristics  of  gout  or  ar- 
thritism. 

As  de  Mussy's  lecture  is  not  readily  avail- 
able, I  quote  from  the  Boston  Journal  some 
of  his  conclusions. 

"I  have  dwelt  at  length  on  the  consti- 
tutional condition  in  order  to  show  in  what 
diathetic  conditions  spasmodic  catarrh  has 
developed.  The  direct  and  collateral  he- 
reditary tendency  appears  to  indicate  a 
diathetic  origin.  The  two  sisters  belong 
to   a   gouty  stock.     Chronic   urticaria   and 


Dr.  Gueneau  de  Mussy  49 

granular  pharyngitis  are  not  rare  in  gouty 
families. 

"Periodicity  is  characteristic  of  many 
arthritic  affections.  The  spring-time  perio- 
dicity is  especially  common  to  them.  The 
periodicity  of  this  coryza  places  it  in  the 
same  category  as  the  arthritic  affections 
which  generally  manifest  themselves  by 
regular  or  irregular  paroxysms. 

"If  hay  fever  has  been  more  often  noticed 
in  England  than  France,  can  this  be  due  to 
the  greater  frequency  of  gout  in  the  former 
country? 

"Continuing  the  study  of  these  analo- 
gies which,  if  not  enough  to  prove  a  com- 
mon origin,  are  enough  to  justify  further 
study  of  the  question,  I  find  in  one  of  my 
patients  a  morbid  condition  due  to  an 
arthritic  source,  i.e.,  an  urticaria  alternat- 
ing with  asthmatic  coryza  (hay  fever), 
the  latter  appearing  with  symptoms  such 
as  injection  and  itching  and  tumefaction  of 
the  eyes  which  recall  the  cutaneous  affection 
to  which  it  had  succeeded.  (Italics  mine. 
Here  is  my  urticaria  theory  expressed  in 
1868.     G.  F.  L.) 

^^  Behind  a  vast  number  of  nervous  troubles, 


50  The  Treatment  of  Ilay  Fever 

behind  a  vast  number  of  bizarre  functional 
anomalies  stamped  with  a  nervous  imprint, 
we  find  arthritistn.'^  (Italics  mine.  Here 
is  my  pet  theory  of  the  gouty  origin  of  neu- 
rasthenia and  perhaps  Beard's  neurotic  can- 
stitution,  beloved  of  rhinologists.     G.  F.  L.) 

"As  to  analogies  between  summer  catarrh 
and  urticaria,  I  wish  to  draw  no  conclu- 
sions from  them.  If  it  be  admitted  that 
both  are  due  to  arthritism,  their  succession 
and  the  analogy  in  their  local  development 
can  be  understood."  (My  urticarial  nature 
of  the  lesion  again.     G.  F.  L.) 

I  might  add  that  de  Mussy  reports  success 
in  preventing  the  appearance  of  the  symp- 
toms by  the  use  of  quinine  for  seven  or  eight 
days  before  the  expected  attack.  During 
the  attack  he  used  sulphur  and  arsenic  for 
the  catarrh. 

In  the  next  chapter  we  will  consider  the 
fate  of  de  Mussy's  theory  of  gout  as  the 
underl}ing  cause  of  hay  fever. 


CHAPTER   VIII 
HAY  FEVER  AS  GOUT 

In  the  last  chapter  we  read  that  the 
theory  of  a  gouty  diathesis  as  the  constitu- 
tional basis  for  hay  fever  originated  with 
Dr.  Gueneau  de  Mussy,  in  1868,  on  account 
of  the  many  resemblances  that  he  found 
between  the  symptoms  of  gout  and  the  symp- 
toms of  hay  fever.  We  have  now  to  con- 
sider the  fate  of  the  de  Mussy  doctrine  in 
those  countries  where  hay  fever  is  best 
known  and  has  been  most  closely  studied, 
Great  Britain  and  America,  Germany  and 
France. 

De  Mussy  in  Great  Britain  and  America. 
If  any  speciahst  on  the  nose  and  throat  in 
England  or  America  ever  heard  of  de  Mussy 
and  his  theory  that  hay  fever  is  rooted  in  a 
gouty  diathesis,  he  is  keeping  the  secret 
well,  for  it  does  not  appear  in  any  of  the  books 
that  he  writes;  but  in  every  book  I  find  the 
disease  attributed  to  the  neurotic  constitu- 
tion first  suggested  by  Beard.     In  this  state- 


52  The  Treatment  of  Bay  Fever 

ment  I  do  not  include  several  references  to 
"uric  acid  posioning"  which  is  not  the  same 
thing  as  gout,  as  will  be  explained  in  Chap- 
ter IX,  on  the  Uric  Acid  Theory. 

After  reading  de  Mussy's  argument  for 
the  dependence  of  hay  fever  on  a  gouty 
diathesis,  I  turned  first  to  the  English  books. 
For  centuries,  England  has  been  famous  as 
the  home  of  gout  and,  since  the  English- 
man, Bostock's,  account  of  his  own  case, 
hay  fever,  too,  like  parliamentary  govern- 
ment and  gout,  has  been  recognized  as  an 
inheritance  of  the  Anglo-Saxon  race.  As 
British  physicians  see  more  gout  than  any 
other  physicians  in  the  world  and  as,  for 
many  years,  they  have  had  the  best  oppor- 
tunities for  the  study  of  hay  fever,  I  turned 
first  to  the  English  books,  thinking  that  if 
there  was  any  truth  in  the  gouty  theor>% 
the  British  physicians  would  have  found  it 
out  long  ago.  To  my  suri:)rise  I  searched 
book  after  book  by  both  British  and  Ameri- 
can authors,  but  in  not  one  instance  did  I 
find  hay  fever  associated  with  gout.  These 
books  included  Allbutt's  System  oj  Medicine^ 
F.  T.  Robert's  Practice,  Lennox  Browne, 
Morell  Mackenzie  in  England  and,  in  this 


Hay  Fever  as  Gout  53 

country,  Ballenger,  Bosworth,  Coakley, 
Kyle,  Solis-Cohen,  Ivins  and  Vehslage  and 
Hallett. 

No  one  is  more  saturated  with  the  tradi- 
tions of  British  medicine  than  Sir  WilUam 
Osier,  but,  in  his  Practice  of  Medicine,  in 
discussing  the  constitutional  causes  of  hay 
fever,  he  seems  to  know  nothing  of  the  gouty 
theory. 

Besides  the  article  on  hay  fever  in  his 
Diseases  of  the  Nose  and  Throat,  Sir  Morell 
Mackenzie  wrote  a  comprehensive  work  on 
Hay  Fever  and  Paroxysmal  Sneezing  that 
ran  through  five  editions  and  bears  on  the 
flyleaf  the  admiring  comment  of  the  London 
Lancet  that  it  "must  be  regarded  as  one  of 
the  most  complete  expositions  of  our  knowl- 
edge of  this  curious  complaint  in  our  lan- 
guage." It  is  a  wicked  joy  to  catch  such  a 
scholarly  writer  as  Mackenzie  napping.  In 
a  footnote  he  even  refers  to  the  de  Mussy 
lecture  in  the  Gazette  hebdomadaire,  Jan.  5, 
1872,  as  calling  the  disease  spasmodic  rhino- 
bronchitis,  with  which  name  the  disease  is 
still  known  in  France.  One  suspects  that 
the  learned  Doctor  was  very  busy  that  day 
and  that  the  footnotes  were  looked  up  by 


54  The  Treatment  of  Hay  Freer 

somebody  else;  for,  though  he  gives  "the 
most  complete  exposition  in  our  language," 
as  the  Lancet  puts  it,  of  the  constitutional 
causes  underlying  hay  fever,  there  is  never 
a  word  of  de  Mussy's  theor}-  of  gout. 

In  Osier  and  McCrae's  Modern  Medicine 
the  article  on  Hay  Fever  is  written  by 
Professor  Dunbar,  of  Hamburg,  deviser  of 
pollantin.  Here  at  last  we  get  away  from 
British  insularity,  for,  in  spite  of  his  Scotch 
name,  Dunbar  is  a  German.  On  page  863 
he  writes: 

"For  a  long  time  it  has  been  believed  that 
the  predisposition  to  hay  fever  rests  on  a 
gouty  diathesis.  This  view  is  not  on  the 
face  of  it  inconsistent  with  the  pollen  theory. 
Inquiries,  however,  have  shown  that  gouty 
persons  form  only  a  small  portion  of  hay 
fever  patients." 

Finally,  in  the  great  Edinburgh  Encyclo- 
pedia Medica,  1900,  Volume  4,  Greville 
MacDonald,  of  London,  in  the  article  on 
Hay  Fever,  seems  to  know  nothing  of  the 
gouty  theory  and  says  innocently  at  the 
end  of  the  article,  "No  special  dietary  is 
indicated,  seeing  that  these  patients  pre- 
sent  no    tendency   to    lithaimia,   etc."     He 


Hay  Fever  as  Gout  55 

makes  the  extraordinary  suggestion  that,  in 
reheving  the  attack  of  hay  fever,  "rather 
than  give  the  patient  cocaine,  it  might  be 
wise  to  allow  the  opium  pipe."  In  the 
early  prescriptions  for  hay  fever,  opium 
sprays  and  nasal  douches  were  common 
enough,  but  this  is  the  only  time  I  ever 
heard  a  reputable  physician  and  a  teacher, 
at  that,  advising  a  patient  to  "hit  the  pipe." 

I  think  that,  from  the  evidence  examined, 
we  may  say  that  British  and  American 
authors  know  nothing  of  de  Mussy  and  his 
theory. 

Next,  I  looked  up  the  gout  authorities, 
Ewart,  Ebstein,  Garrod,  Falkenstein,  Lan- 
cereaux,  Lecorche,  each  of  whom  wrote  a 
bulky  treatise  on  Gout,  but  there  is  never 
a  word  on  Hay  Fever. 

De  Mussy  in  Germany.  For  many  years, 
whenever  I  have  wanted  to  know  anything 
from  the  bottom  up,  historically,  linguist- 
ically, philosophically,  I  have  turned  to  a 
German  book  and  have  always  found  what 
I  was  looking  for,  if  it  is  known  to  man. 
Where  an  American  or  British  author  will 
skim  over  or  touch  a  subject  carelessly,  not 
seeming  to  care  where  the  idea  comes  from 


56  The  Treatment  of  Hay  Fever 

or  its  relation  to  other  ideas  in  different 
times  or  countries,  a  German  will  plow  stead- 
ily through  the  matter  from  Hammurabi  to 
Wilhclm  III  and  lay  bare  all  the  collateral 
tributaries  and  branches,  always  with  an 
index  at  the  end. 

First  I  tried  Heymann's  TIandbuch  dcr 
Laryngologic  iind  EJiinologie  (Wien  1900) 
and  found  hay  fever  described  in  the  article 
on  Die  Nasalen  Rejlexneurosen ,  by  Pro- 
fessor Jurasz  in  Heidelberg;  but  there  was 
no  mention  of  gout.  By  this,  I  was  truly 
convinced  that  nothing  was  known  on  the 
subject.  If  a  Heidelberg  Herr  Professor 
does  not  know  it,  it  does  not  exist.  And 
''Professor  Jurasz  in  Heidelberg"  had  failed 
me. 

However,  looking  further  in  Heymann, 
my  faith  in  German  thoroughness  and  all- 
inclusiveness  revived.  Hay  fever  appears 
also  in  the  article  on  Acute  Rhinitis,  by 
P.  H.  Gerbcr,  of  Konigsberg,  and  here,  on 
page  371,  we  fmd  a  complete  "Literatur" 
spread  out  in  true  Teutonic  style  from  Bos- 
tock  to  date.  However,  Gerber  does  not 
discuss  the  matter  of  gout  in  the  text,  but 
says  merely,  "Recently  Bishop  asserts  that 


Hay  Fever  as  Gout  57 

the  nervous  disturbances  of  hay  fever  are 
due  to  an  excess  of  uric  acid  in  the  blood." 

The  gouty  theory  of  hay  fever  receives 
scanty  recognition  from  most  German  writ- 
ers. Striimpell  does  not  mention  it.  In 
his  Handbuch  der  Specielle  Pathologie  und 
Therapie,  Berhn  and  Wien,  1904,  Eichorst 
says  skeptically,  page  326,  "It  has  been 
stated  often  that  gouty  familes  are  especially 
apt  to  develop  hay  fever,"  and  on  page  330 
"Grote  saw  hay  fever  patients  of  gouty 
famihes  cured  (?)  by  a  course  of  waters  at 
Neuenahr." 

In  Eulenberg's  Real-EncyclopcBdie  der  ge- 
sammten  Heilkunde,  1887,  page  509,  article 
Hay  Fever,  we  read: 

"Of  general  diseases,  malaria  and  gout 
have  been  advanced  as  the  basis  of  hay 
fever,  but  without  convincing  proof." 

We  may  conclude,  then,  that  while  British 
and  American  physicians  know  nothing  about 
the  gout  theory,  German  physicians  know 
about  it  but  do  not  believe  it. 

Finally,  in  my  wanderings  through  Ger- 
man encyclopaedias,  I  came  to  the  many- 
volumed  Nothnagel  and  here,  at  last,  found 
a  modern  writer  who  knew  de  Mussy  and 


58  The  Treatment  oj  Hay  Fever 

recognized  the  importance  of  his  observa- 
tions. At  the  end  of  Volume  4  there  is  a 
monograph  on  Hay  Fever  by  Dr.  George 
Sticker,  of  the  University  of  Giessen,  the 
most  thorough  and  satisfactory  book  on 
the  subject  that  I  have  found.  It  may  be 
read  in  Enghsh  in  the  American  edition  of 
Nothnagel,  Philadelphia,  1902.  Sticker  re- 
sists the  impulse  to  begin  with  Galen, 
though  he  notes  rather  wistfully  that  John 
Mackenzie  of  Baltimore  succumbs  to  it. 
He  gives  the  most  complete  statement  in  any 
modern  book  of  the  gout  theory  of  hay  fever, 
but,  alas,  Sticker  misses  the  pearl  in  the 
oyster.  He  says  nothing  of  de  Alussy's 
recognition  of  the  urticarial  nature  of  the 
lesion  in  hay  fever. 

As  this  volume  of  Nothnagel  may  not  be 
easily  available  to  the  gentle  reader,  I  copy 
a  paragraph  from  Sticker  for  his  or  her 
benefit. 

Nothnagel's  Specielle  Pathologie  utid 
Therapie,  Band  4,  1896.  Article  Bostock's 
Catarrh,  by  Dr.  George  Sticker,  page  118. 
"In  the  last  few  years  convincing  proofs 
are  accumulating  that  there  is  a  certain 
constitutional  disorder  on   which    the  indi- 


Hay  Fever  as  Gout  59 

vidual  tendency  to  hay  fever  depends. 
Though  further  careful  proof  is  desirable, 
it  can  scarcely  be  doubted  that  the  patho- 
genesis of  hay  fever  is  based  on  that  consti- 
tution that  the  English  and  French  describe 
as  arthritic,  which  expresses  itself  in  a 
hereditary  or  family  tendency  to  rheuma- 
tism, gout,  diabetes,  obesity,  migraine,  furun- 
culosis,  bronchitis,  asthma,  etc.  Bostock 
himself  mentioned  his  gouty  tendency. 
Phoebus  found  it  in  many  patients.  But 
it  was  Gueneau  de  Mussy  who  first  recognized 
the  prevalence  and  necessary  basis  of  the 
disease  in  the  arthritism  of  the  hay  fever 
patient;  and  his  teaching  has  been  accepted 
and  enriched  with  new  material  by  Herbert, 
Leflaive,  Lermoyez,  Ruault,  de  Dreyfus- 
Brissac,  Rendu,  Molinie.  .  .  .  And  so  it  is 
probably  no  coincidence  that,  like  gout, 
the  morbus  principum  of  Sydenham,  so 
also  the  aristocratic  hay  fever  is  a  preroga- 
tive of  the  Anglo-Saxon  race." 

Reading  this  praise  of  Englishmen  and 
Frenchmen  by  a  German  makes  one  sad 
to-day.  Hasten  the  day  when  the  old 
hearty  comradeship  in  science  will  return, 
the  day  when  German  and  Frenchman  and 


6o  The  Treatment  of  Hay  Fever 

Englishman  will  again  praise  one  another's 
achievements  ungrudgingly  and  each  learn 
eagerly  as  of  old  what  the  other  had  to  teach. 
De  Mussy  in  France.  As  might  be 
expected,  among  French  rhinologists  and 
writers  on  general  medicine,  de  Mussy's 
teaching  is  well  known  and  has  many 
advocates.  Note  that  the  writers  mentioned 
by  Stickerare  all  Frenchmen.  The  usual 
view  is  well  expressed  by  Andre  Castex  in 
his  Maladies  du  Larynx,  du  Nez  et  des 
Oreilles.     Paris,  1907,  page  425. 

"Hay  fever  attacks  especially  those  who 
belong  to  an  arthritic  stock,  whose  parents 
have  had  or  who  themselves  have  migraine, 
gravel,  eczema.  This  explains  its  frequency 
in  England  and  America;  for  the  Anglo- 
Saxon  race  is  especially  subject  to  arthritic 
disorders.  In  France  it  exists  but  is  in- 
frequent. In  this  way  also  we  must  ex- 
plain why  hay  fever  is  rare  among  the 
laboring  classes  who  frequent  the  hospitals 
and  is  observed  almost  exclusively  among 
wealthy  patients,  people  of  sedentary  habits 
and  sluggish  digestion  (nutrition  ralentie)." 

In  Brouardel  and  Gilbert's  Traitc  de  Medi- 
cine et  de  Thcrapcutique,  Volume  27,  page  66, 


,  Hay  Fever  as  Gout  6i 

another  Andre,  Andre  Cartaz,  expresses 
mild    skepticism    as    to    the   proof   offered. 

"The  presence  of  an  arthritic  diathesis  is 
accepted  by  many  authors.  Leflaive  thinks 
it  the  sole  predisposing  cause,  especially 
gout.  During  the  attack  he  has  demon- 
strated, as  I  would  say,  and  that  is  proof 
for  him,  an  appreciable  decrease  in  the 
quantity  of  urine  and  percentage  of  urea, 
an  increase  in  uric  acid  and,  in  one  case, 
the  presence  of  indican." 

Lermoyez  also  advises  caution  in  accept- 
ing the  gouty  theory  to  the  neglect  of  known 
remedies  for  the  disease.  I  abstract  his 
sensible  remarks  from  his  TherapeuHque 
des  Maladies  des  Fosses  Nasales,  Paris,  1896. 
Article  Rhinites  spasmodiques,  rhume  des 
Joins,  page  300. 

"It  would  be  a  mistake  to  hold  with  the 
German  school  that  the  nasal  lesions  were 
the  only  cause  of  hay  fever;  for  these  lesions 
are  completely  absent  in  many  true  cases 
of  the  disease  and,  on  the  other  hand,  many 
people  affected  with  hypertrophic  rhinitis 
breathe  air  full  of  pollen  without  showing 
symptoms  of  hay  fever.  There  is  certainly 
a    general     predisposition.     In     hay    fever 


62  The  Treatment  oj  II ay  Fever 

certain  patients  present  a  peculiar  idiosyn- 
crasy, often  inherited,  almost  always  neuro- 
arthritic.  But  to  say  with  the  French  school 
that  the  arthritic  diathesis  (trivial  diathesis, 
commonplace  diathesis,  diathese  banale)  is 
the  only  cause  of  hay  fever  is  to  make  a 
mistake  that  leads  to  inefficient  treatment." 

Conclusion.  How  this  discussion  of  the 
gouty  nature  of  hay  fever  escaped  English 
and  American  authors  is  a  strange  thing. 
British  physicians  frequent  French  hospitals 
and  are  familiar  wdth  French  medical  writ- 
ings. In  1868  American  physicians  studied 
in  Paris  as  they  went  later  to  Vienna  and 
Berlin.  It  is  strange  that  they  never  brought 
back  with  them  this  French  theory  of  the 
gouty  nature  of  hay  fever  and  that  no  Brit- 
ish or  American  author  seems  to  have  quoted 
from  their  books. 

I  must  make  one  partial  exception  to  this 
statement.  In  his  Diseases  of  the  Nose, 
Throat,  and  Ear,  Philadelphia,  1906,  Pro- 
fessor Grayson  says  that,  in  hay  fever,  there 
is  "some  diathetic  state  that  is  rooted  in 
defective  nutrition.  Whether  we  term  this 
lithx'mia  or  gout  or  uric  acid  diathesis  is  im- 
material, the  central  fact  being  that  through 


Hay  Fever  as  Gout  63 

intestinal  toxaemia  or  some  disturbance  of 
normal  metabolism  we  have  resulting  a  per- 
sistent poisoning  of  the  blood-current." 

Now  this  is  simply  substituting  one  theory 
for  another  without  proof  of  either;  for 
the  origin  of  hay  fever  in  auto-intoxication 
is  as  little  proved  as  its  origin  in  gout  or 
uric  acid.  Auto-intoxication  has  simply  re- 
placed uric  acid  in  the  Doctor's  mental 
picture  gallery;  for,  like  uric  acid,  auto-in- 
toxication often  exists  in  the  imagination  of 
the  physician  and  not  in  the  patient.  For 
further  discussion  of  this  point,  the  reader  is 
referred  to  the  next  chapter,  on  the  Uric 
Acid  Theory. 

A  novel  and  interesting  article  in  Grayson 
is  the  description  of  angioneurotic  oedema 
as  afifecting  the  nose  and  throat,  page  182. 
He  writes: 

"I  have  no  doubt  that  in  this  disease,  as 
in  hay  fever,  the  gastro-intestinal  tract  is 
the  birthplace  of  the  toxic  material.  Al- 
though the  disease  may  occur  in  gouty  or 
rheumatic  individuals,  there  is  scarcely  suffi- 
cient reason  for  ascribing  any  pathological  con- 
nection between  it  and  these  other  afifections." 

The  conmient  on  this  is  that,  until  we 


64  The  Treatment  of  Ilay  Fever 

know  what  gout  is,  which  we  do  not  at 
present,  we  cannot  argue  satisfactorily  either 
way.  Some  day  I  shall  tell  a  listening  world 
what  I  know  about  gout.  I  shall  elaborate 
my  favorite  theory  that  the  American  neu- 
rasthenia, now  rapidly  increasing  in  other 
countries,  is  a  form  of  gout,  a  gout  of  the 
nervous  system.  And  here,  too,  I  find  that 
Frenchman,  de  Mussy,  anticipating  me  in 
his  remark  that  '^Behind  a  vast  number  of 
nervous  troubles,  behuid  a  vast  number  of 
functional  anomalies  stamped  with  a  nerv- 
ous imprint,  we  find  arthritism.'^  The  name 
neurasthenia  was  not  known  in  de  Mussy's 
day,  but  he  hit  off  the  condition  neatly  as 
"functional  anomalies  stamped  with  a  nerv- 
ous imprint." 

The  defect  in  all  these  discussions  of  the 
gouty  or  non-gouty  nature  of  hay  fever 
or  of  neurasthenia  is  our  lack  of  a  sure 
diagnostic  sign  of  the  disease  gout.  Gout 
occurs  in  two  forms,  typical  and  atypical, 
irregular  gout.  In  typical  gout,  with  the  de- 
posits of  urates  in  the  joints  and  cartilages, 
the  diagnosis  may  be  easy.  In  atypical  or 
irregular  gout  we  may  have  a  group  of  in- 
flammations  or   functional    disturbances    in 


Hay  Fever  as  Gout  65 

any  tissue  of  the  body.  From  their  frequent 
occurrence  in  gouty  people,  we  suspect  them 
to  be  gouty,  but  can  prove  nothing.  When 
they  appear  in  people  who  have  never  had 
typical  gout  we  can  only  say  that  a  gouty 
origin  is  probable.  There  is  no  sign  in  the 
blood  or  in  the  urine  or  anywhere  else  by 
which  we  can  say  that  gout  is  or  is  not  pres- 
ent. It  is  in  this  class  of  atypical  gout  that 
hay  fever  and  neurasthenia  belong,  if  they 
be  gouty  at  all.  Until  somebody  discovers 
a  diagnostic  sign  of  gout  that  is  available  in 
these  irregular  cases,  the  evidence  of  the 
gouty  nature  of  hay  fever  and  neurasthenia 
must  remain  exactly  what  it  was  to  de  Mussy 
fifty  years  ago,  analogies  of  symptom  groups, 
and  not  an  exact  laboratory  diagnosis  based 
on  physiological  or  chemical  tests  such  as 
we  have  come  to  depend  upon  with  such 
confidence  in  recent  years. 

One  matter  that  should  be  made  clear  in 
the  reader's  mind  is  that  the  so-called  uric 
acid  poisoning  or  uricacidcemia  is  not  the 
same  thing  as  gout  by  any  means,  though 
Grayson  confuses  it  with  gout,  as  do  nearly  all 
American  authors.  For  fuller  discussion  of 
this  point,  we  will  pass  to  the  next  chapter. 


CHAPTER   IX 
THE  URIC  ACID   THEORY 

Uric  acid  is  a  substance  about  which 
more  has  been  written  and  less  understood 
than  many  others  in  medicine  and  that  is 
saying  a  great  deal.  As  a  basis  of  the  sub- 
oxidation  theory  of  Bence  Jones'  day,  as 
the  cause  of  gout  with  Garrod,  as  a  step  in 
our  knowledge  of  metabolism  and  as  a  popu- 
lar fad,  uric  acid  in  its  time  has  played  many 
parts. 

Uric  Acid  in  Hay  Fever.  In  1893,  Dr. 
Seth  Bishop  announced  before  the  American 
Medical  Association  that  "excess  of  uric 
acid  in  the  blood  causes  hay  fever  and 
nervous  catarrh;"  and  advised  elimination 
and  control  of  the  uric  acid  as  the  principle 
of  treatment.  The  article  may  be  found 
in  the  Journal  of  the  American  Medical 
Association,  1893,  and  abstracted  with  an 
interesting  discussion  on  the  treatment  of 
hay  fever,  in  the  Philadelphia  Medical  News, 
1894.     This  position,  of  course,  is  also  that 


The  Uric  Acid  Theory  67 

of  Haig  {Uric  Acid,  seventh  edition,  page 
386)  and  his  followers. 

Now,  in  1893,  the  theory  of  uric  acid 
poisoning  flourished  like  a  green  bay  tree 
and  all  sorts  of  queer  and  misunderstood 
pathological  processes  came  and  roosted  in 
its  branches.  Patients  came  to  our  offices, 
not  complaining  of  headache  or  lumbago 
or  cough,  but  asking  for  "something  for 
that  uric  acid."  As  patients  will,  they  had 
already  made  the  diagnosis  from  the  news- 
papers and  wished  our  advice  only  for  the 
remedy. 

As  the  basis  of  hay  fever,  this  theory  of 
uric  acid  poisoning  has  apparently  made  as 
little  impression  as  de  Mussy's  theory  of 
gout  on  the  nose  and  throat  speciaUsts  of 
this  country  and  Great  Britain;  for  I  find 
no  mention  of  it  in  their  books,  except  the 
brief  reference  of  Professor  Grayson  quoted 
in  the  preceding  chapter.  In  the  Virginia 
Medical  Monthly,  however,  I  find  an  in- 
teresting paper  by  Dr.  John  Dunn,  Professor 
of  Diseases  of  the  Nose  and  Throat  in  the 
University  Medical  College  of  Richmond, 
Virginia.  Following  the  suggestions  of  Dr. 
Bishop,  Dr.  Dunn  treated  his  patients  with 


68  The  Treatment  of  Hay  Fever 

diet  and  alkalies  according  to  the  uric  acid 
theory  and  reports  excellent  results. 

It  may  be  pointed  out  that  the  successful 
results  of  the  treatment  by  no  means  prove 
that  the  condition  was  due  to  uric  acid; 
for  the  diet  may  be  doing  many  other  things 
besides  controlling  the  movements  of  the 
uric  acid  and  it  is  probable  that  the  effect 
of  an  alkali  in  the  blood  is  not  a  simple 
neutralizing  of  an  acid  but  that  it  sets  in 
motion  a  train  of  chemical  changes  of  great 
complexity.  None  the  less,  Dr.  Dunn's 
paper  is  well  worth  reading  by  every  physi- 
cian for  its  practical  suggestions  in  the  treat- 
ment of  hay  fever. 

The  cardinal  error  made  by  the  advo- 
cates of  the  uric  acid  poisoning  is  that  they 
name  the  poison.  If  the  theory  were  stated 
that  an  unknown  poison  or  poisons  circu- 
late in  the  blood  and  cause  many  symptoms 
of  disease,  as  headache,  gouty  pains,  bilious 
vomiting,  and  so  on,  we  would  all  agree  that 
this  is  so.  Call  it  the  X-poison,  if  you  will, 
as  Roentgen  did  with  his  unknown  ray. 
But  when  you  name  the  poison  uric  acid^ 
you  challenge  the  chemist  and  the  physi- 
ologist   to    test  your  doctrine  by   chemical 


The  Uric  Acid  Theory  69 

analysis,  and  when  the  uric  acid  doctrine  is 
tested  in  this  way  it  is  found  sadly  wanting. 

It  is  true  that  uric  acid  in  the  form  of 
urates  is  found  in  the  blood  in  varying  quan- 
tities, but  there  is  no  proof  that  it  does  any 
harm  there.  In  fact,  there  is  good  evidence 
that  it  does  not.  In  the  disease,  leukaemia, 
there  is  an  enormous  amount  of  uric  acid 
in  the  blood,  far  more  than  was  ever  dem- 
onstrated in  gout  or  the  so-called  urid-acid 
disorders;  yet,  in  leukaemia,  there  are  no 
symptoms  of  gout  or  any  other  symptoms 
that  have  been  attributed  to  uric  acid  poi- 
soning. 

A  second  error  of  the  uric  acid  advocates, 
flowing  from  their  first  error  of  naming  the 
poison,  is  to  pour  their  acids  and  alkalies 
into  the  blood  with  the  childlike  faith  that, 
like  good  children,  the  acids  and  alkaUes 
will  go  in  there  and  do  just  what  they  were 
told  to  do,  neutralize  the  uric  acid,  and  get 
out.  They  assume  that  the  chemistry  of 
the  acids  and  alkalies  is  as  simple  inside  of 
the  body  as  it  is  outside  of  it  and  that  the 
blood  is  simply  a  passive  mixture  of  chemi- 
cals. 

A  third  error  of  the  uricacidites  is  to  talk 


70  The  Treatment  oj  Hay  Fever 

so  glibly  of  the  chemistry  of  the  blood  and 
the  influence  of  this  or  that  food  or  medi- 
cine on  its  chemical  changes.  The  chemis- 
try of  blood!  A  subject  of  which  the  ablest 
physiological  chemists  have  but  touched 
the  fringe,  —  is  that  a  knot  to  be  unloosed 
familiar  as  his  garter  by  an  amateur  with 
a  watch-glass  and  a  thread? 

In  his  Lehrbuch  dcr  Organischen  Chemie 
fur  Mediciner,  Leipzig,  1906,  Bunge  ob- 
serves slyly  that  he  had  "sometimes  had 
occasion  to  remark  in  i)rivate  that  the  less  a 
physiologist  knew  about  chemistry,  the  more 
irresistible  was  his  impulse  to  undertake 
the  most  difiicult  subjects." 

When  the  uric  acid  amateur  chemist  comes 
to  study  the  real  poisons  of  the  blood,  he 
will  be  confronted  with  a  problem  even 
more  intricate  than  uric  acid,  though  that 
one  is  intricate  enough  and  still  unsolved. 
For  there  are  "poisons  in  the  blood,"  though 
it  is  improbable  that  uric  acid  is  one  of  them. 
These  poisons  are  the  blood-proteins,  so 
many  that  the  physiologist  has  never  counted 
them,  so  minute  in  quantity  that  no  chemist 
has  ever  isolated  them,  so  complex  in  struc- 
ture that  the  ablest  chemists  of  the  world 


The  Uric  Acid  Theory  71 

stand  appalled  before  a  molecule  that  con- 
tains sixty  atoms  of  carbon,^  so  powerful 
that  an  undetermined  fraction  smaller  than 
one-third  of  a  grain  will  kill  ten  thousand 
guinea  pigs  or  one  hundred  thousand  mice, 
and  so  perfectly  under  control  that  they 
circulate  harmlessly  in  the  normal  blood. 
The  marvel  is  that  any  animal  remains 
ahve;  and  no  animal  would  remain  alive 
were  it  not  for  a  system  of  protection  by 
which  these  poisons  are  rendered  harmless, 
usually  by  a  slight  rearrangement  of  the 
atoms  in  their  molecule  which  is  one  of  the 
wonders  of  organic  chemistry. 

We  are  far  from  knowing  just  what  hap- 
pens when  we  pour  acids  and  alkahes  and 
foods  into  this  witches'  cauldron  of  blood. 
Rather  than  impudently  announcing  the 
changes  that  are  about  to  take  place  in  the 
blood  when  we  administer  a  certain  food  or 
medicine,  we  should  stand  in  reverent  awe 
before  one  of  the  most  intricate  and  mar- 

^  Wenn  mehr  als  60  Atome  KohlenstofiE  im  Molekul 
sind,  dann  ueberlasse  ich  das  Object  zu  andern.  Bunge, 
page  262,  quoting  "einen  hervorragenden  Forscher  auf 
dem  Gebiete  der  organischen  Chemie."  See  Bunge  for 
authority  of  these  statements. 


7  2  The  Treatment  of  11  ay  Fever 

velous  puzzles  with  which  nature  ever  chal- 
lenged   the    chemist    and    the    physiologist. 

Shall  we  therefore  stop  using  acids  and 
alkalies  as  medicines  because  we  do  not 
know  each  step  in  their  mode  of  action? 
By  no  means.  We  do  not  know  each  step 
in  the  mode  of  action  of  any  medicine  or  of 
our  foods,  either,  for  that  matter;  but  we 
do  not  for  that  reason  stop  eating.  VVe 
should  still  use  the  acids  and  alkalies  for 
their  effect  on  the  patient  as  far  as  we  can 
see  it  just  as  we  shall  still  go  on  eating  food 
because  it  nourishes  us;  but  we  shall  be 
wise  to  stop  talking  so  glibly  about  what 
we  cannot  see  and  do  not  yet  know,  the 
effect  of  those  acids  and  alkalies  on  the 
chemistry  of  the  blood. 

Uricacidaemia  and  Gout.  Now,  why  do 
I  speak  with  respect  of  de  Mussy's  theory 
of  gout  as  a  cause  of  hay  fever  and  so  dis- 
respectfully of  the  uric  acid  doctrine?  Are 
not  gout  and  uric  acid  poisoning  the  same 
thing?  No.  They  are  not;  though  the 
two  ideas  are  usually  confused  by  medical 
men  since  Garrod's  time  and  his  demonstra- 
tion of  the  increase  and  decrease  of  uric 
acid  in  the  blood  of  gouty  j)atients.     Gout 


The  Uric  Acid  Theory  j$ 

is  something  more  than  a  simple  accumu- 
lation of  uric  acid  in  the  blood  because 
of  its  imperfect  elimination  by  the  kidneys. 
What  that  something  is,  we  do  not  know; 
but  gout  is,  at  least,  a  clinical  entity,  a 
definite  group  of  symptoms  known  since 
Hippocrates'  time.  Take  away  the  uric 
acid  theory  and  you  still  have  the  disease, 
gout,  that  any  of  us  can  recognize,  as  the 
Greeks  and  Romans  recognized  it  when  the 
word  uric  acid  was  unknown.  It  is  on  these 
symptoms  of  gout,  the  clinical  picture  of 
disease,  not  on  any  hypothetical  uric  acid, 
that  de  Mussy  based  his  theory  and  thus 
far  he  is  on  solid  ground.  On  the  other 
hand,  uric  acid  poisoning  is  largely  a  figment 
of  the  imagination.  Take  away  the  uric 
acid,  which  has  never  been  satisfactorily 
proved  to  be  there,  and  there  is  nothing  left. 
In  not  one  one-hundredth  part  of  the  cases 
of  so-called  uric  acid  poisoning  is  it  proved 
that  uric  acid  has  anything  to  do  with  the 
case. 

The  Deposits  of  Uric  Acid  in  Gout. 
The  deposit  of  uric  acid  in  the  form  of 
urates  in  the  gouty  joint  has  always  been 
a  strong  argument  for  the  theory  that  gout, 


74  The  Treatment  of  Hay  Fever 

at  least,  is  due  to  an  excess  of  uric  acid 
(urates)   in   the  blood.     At  one  time,  in  a 
humble  way,  I  was  a  pathologist,  and  this 
theory  of  a  blood  overioaded  with  uric  acid 
as    the   only   thinkable    cause    of    its  dep- 
osition   in    the    joints    never  impressed  me 
as    pathologically    sound.     I    often    com- 
pared these  deposits  of  urates  in  the  joints 
with  the  deposits  of  lime  salts  so  often  found 
at  autopsies  in  caseous  glands  or  small  ne- 
crotic areas.     The  superficial  observer  says: 
"See  what  an  excess  of  lime  salts  there 
must  have  been  in  the  blood."     He  is  think- 
ing of  laboratory  glassware  and  the  ground 
around  a  mineral  spring  that  becomes  en- 
crusted with  salts  as  the  solutions  evaporate. 
But,   in   animal  pathology,   this  is   a   false 
conclusion.     The    animal    body    is    not    a 
test-tube   and,    in   it,    the   laws   of   physics 
are  modified  by  those  of  physiology.     Lime 
salts  are  deposited  in  the  caseous  gland  or 
tubercle  not  because  they  are  in  excess  in 
the  blood   but   because   lime   salts   are   at- 
tracted to  all  caseous  material  from  normal 
blood.     Whether  or  not  this  calcification  is 
an  intentional  provision  of  nature  to  protect 
the  body,  to   petrify  the  necrotic  material 


The  Uric  Acid  Theory  75 

and  make  it  harmless,  is  not  the  ques- 
tion here,  though  the  calcification  has  this 
effect.  The  point  here  is  that  calcification 
of  caseous  glands  or  necrotic  areas  does  not 
presuppose  an  excess  of  lime  salts  in  the 
blood.  The  first  step  is  not  an  excess  of 
lime  in  the  blood  but  a  necrosis,  after  which 
the  Hme  salts  will  be  deposited  from  normal 
blood. 

So,  it  has  seemed  to  me  that  the  deposit 
of  urates  in  and  around  a  joint  is  no  proof 
of  their  excess  in  the  blood.  Just  as  in  cal- 
cification, so  in  gout,  the  first  step  may  be 
a  minute  area  of  necrosis  or  other  local 
degeneration  that  attracts  the  urates  that 
are  always  present  in  normal  blood;  or 
the  secret  of  the  gouty  inflammation,  like 
that  of  urticaria  and  hay  fever,  may  at  last 
be  found  in  Anaphylaxis,  as  described  in  the 
next  chapter. 


CHAPTER   X 

HAY  FEVER  AS  ANAPHYLAXIS 
THE  GOUTY  DIATHESIS  REAPPEARS 

Fifty  years  ago  de  Mussy  pointed  to  the 
resemblance  between  hay  fever  and  gout 
and  claimed  hay  fever  as  a  manifestation 
of  the  gouty  diathesis.  As  related  in  Chap- 
ter VII,  he  based  his  theory  on  the  resem- 
blance between  the  history  and  symptoms 
of  hay  fever  patients  with  those  of  gouty 
patients.  In  his  day  he  found  both  hay 
fever  and  gout  confined  to  the  Anglo-Saxon 
race,  both  hereditary  and  famihal,  both 
exhibiting  urticaria,  eczema,  and  asthma, 
and  he  recognized  that  the  lesion  in  the  eyes 
and  nose  of  the  hay  fever  patient  was  not  a 
true  catarrh  but  an  urticaria. 

On  the  other  hand,  Wolff-Eisner  declared 
that  hay  fever  is  an  anaphylaxis  and  this 
idea  has  been  developed  and  confirmed  by 
Koessler  and  others  so  fully  that  we  must 
accept  it  as  proven.  Let  us  examine  this 
matter  of  anaphylaxis  to  determine  whether 


Hay  Fever  as  Anaphylaxis  77 

after  all  there  is  any  essential  difference 
between  the  two  views  of  hay  fever. 

Anaphylaxis.  The  conception  anaphy- 
laxis or  lack  of  protection  begins  with  the 
discovery  that  a  harmless  protein  injected 
into  a  dog  will  so  sensitize  him  that,  after 
ten  days  or  so,  another  injection  of  the  same 
protein  will  kill  him.  The  point  is  that  the 
change  has  occurred  in  the  animal,  not  in 
the  protein  injected.  The  protein  is  the 
same  as  before  and  can  be  injected  once  into 
any  number  of  dogs  without  harm.  In 
this  way  we  explain  the  cases  in  which  drugs 
and  foods  that  are  harmless  to  most  people 
may  be  virulent  poisons  to  those  who  happen 
to  have  been  sensitized  by  a  former  over- 
dose. The  widespread  use  of  antitoxin 
in  diphtheria  gave  abundant  opportunity 
to  study  the  phenomena  of  sensitizing  a 
human  being  with  one  dose  and  killing  him 
with  another  dose  of  the  same  thing. 

The  symptoms  of  anaphylaxis  first  ob- 
served were  urticaria,  arthritis,  and  dyspnoea. 
Then  Bruck  showed  that  what  we  used  to 
call  idiosyncrasy  to  drugs  and  foods  that  are 
harmless  to  most  people  is  really  an  ana- 
phylaxis,   attributable    to    a    former    over- 


78  The  Treatment  of  Ilay  Fever 

dose  of  the  same  thing.  Next,  it  was 
learned  that  anaphylaxis  may  persist  through 
life  and  be  transmitted  to  the  oflspring  of 
rabbits  and  guinea-pigs,  illustrating  the 
cases  in  human  families  where  sensitiveness 
to  a  certain  food  or  drug  runs  down  through 
several  generations.  Then  the  dermatologist 
brought  in  a  list  of  skin  eruptions,  urticaria 
in  the  lead,  as  examples  of  anaphylaxis  to 
certain  foods  or  to  poisons  generated  within 
the  body,  especially  in  the  intestines.  Then 
asthma  was  included  among  the  anaphylactic 
reactions  and,  finally,  Wolff-Eisner  pointed 
out  that  the  lesion  of  hay  fever  is  an  ana- 
phylaxis. I  "may  add  here  that  this  view 
of  hay  fever  confirms  my  observation  that 
the  lesion  is  not  a  catarrhal  inflammation 
but  an  urticaria. 

So  we  have  a  picture  of  anaphylaxis  as 
a  sensitiveness  to  bacterial  poisons  or  to 
foods  or  drugs  that  are  harmless  to  most 
people  expressing  itself  as  an  urticaria,  an 
arthritis,  an  asthma  or  hay  fever.  But 
this  is  the  very  group  of  symptoms  on  which 
de  Mussy  based  his  theory  of  gout.  When 
we  add  that  this  sensitiveness  or  anaphy- 
laxis is  hereditary  and  that  it  is  aggravated 


Hay  Fever  as  Anaphylaxis  79 

by  foods,  drugs,  or  pollens  that  are  harmless 
to  most  people,  I  submit  that  we  have  a 
pretty  picture  of  the  gouty  diathesis;    for 
the  gouty  diathesis,  too,  is  a  susceptibility 
to    arthritis,  to    urticaria,    and    to    asthma 
from  causes  that  do  not  trouble  other  people, 
and  in  gout,  too,  this  weakness  is  hereditary. 
One  thinks  of  the  gouty  patient  who  cannot 
take  iron  or  digitalis  because  it  aggravates 
the  gouty  pain  and  of  the  attack  of  gout 
that  is  brought  on  by  a  glass  of  champagne 
or  a  piece  of  beef  or  a  few  strawberries  that 
the  majority   of  mankind  can   take  freely 
without  harm.     Now,  if  urticaria,  eczema, 
arthritis,    asthma   and    hay    fever    form    a 
picture  of  anaphylaxis,  and  if  these  symp- 
toms also   form  the  picture  of   the  gouty 
diathesis,  is  it  not  probable  that  one  of  these 
pictures  can  be  explained  in  the  terms  of 
the  other?    If  the  anaphylaxis  to  the  diph- 
theria antitoxin,  horse  serum,  can   develop 
arthritis,  is  it  not  probable  that  the  most 
striking  feature  of  gout,  the  inflammation 
of  the  joint,  is  also  an  anaphylaxis  to  poisons 
yet  unknown  to  us  but  the  same  poisons 
that  make  the  gouty  urticaria  and  asthma? 
What  if  gout  should  prove  to  be  a  sensi- 


So  The  Treatment  of  Hay  Fever 

tization  or  anaphylaxis  to  uric  acid  that  does 
not  exist  in  the  non-gouty?  This  would 
explain  the  puzzle  of  one  patient  full  of  gouty 
pains  with  very  little  uric  acid  in  his  blood 
while  another  patient,  like  the  leukicmic, 
has  a  blood  full  of  uric  acid  that  does  not 
trouble  him. 

The  Mechanism  of  Anaphylaxis  in 
Hay  Fever.  The  anaphylaxis  theory  of 
hay  fever  is  based  on  the  observation  that 
the  epithelial  cells  of  the  mucous  membranes 
of  the  eyes,  nose,  and  throat  have  not  lost 
their  primitive  power  of  digesting  foreign 
protein. 

Ages  ago,  when  we  were  amoebae  or  little 
drops  of  protoplasm,  we  had  no  eyes  or  nose 
or  separate  stomach  for  digesting  food.  The 
one  little  cell  body  did  everything.  One  of 
the  most  important  powers  of  that  cell 
body  was  its  power  of  digesting  and  assimi- 
lating food,  and  its  most  important  food  was 
the  nitrogenous  food  or  protein  from  which 
it  built  up  its  own  body  substance.  Now, 
foreign  or  food  protein  cannot  be  simply 
absorbed  as  such.  Foreign  protein  is  a 
poison  and  never  tolerated  in  the  blood. 
The  foreign  protein  used  as  food  must  first 


Hay  Fever  as  Anaphylaxis  8i 

be  changed  into  the  special  kind  of  protein 
that  the  body  can  use.  The  foreign  pro- 
tein is  changed  by  spHtting  its  molecule  into 
its  simplest  parts  and  then  recombining 
them  in  the  desired  form.  The  complex 
protein  molecule,  containing  those  sixty 
atoms  of  carbon  that  gave  the  Schreckhch- 
keit  to  the  German  professor  of  chemistry 
as  related  on  page  71,  is  split  up  again  and 
again  into  simpler  forms.  The  end  prod- 
ucts are  harmless,  but  the  early  splittings 
produce  both  poisonous  and  non-poisonous 
products.  The  end-results  of  these  suc- 
cessive splittings,  the  splinters,  as  it  were, 
are  then  combined  by  the  amoeba  to  form  its 
own  kind  of  protein  or  body  substance. 

As  we  rose  in  the  animal  scale,  instead 
of  being  an  amoeba  of  a  single  cell,  we 
became  constructed  of  millions  of  tiny  cells 
and  began  to  set  aside  certain  groups  of 
cells  to  do  special  work,  the  eyes  for  see- 
ing, the  ears  for  hearing,  the  lungs  for  breath- 
ing, the  digestive  organs  to  prepare  our 
food  and  a  sheath  of  harder  cells  over  the 
outside  of  the  body  that  we  call  our  skin 
and  mucous  membranes.  Specialized  as 
those  cells  have  been  for  many  generations, 


82  The  Treatment  of  Ilay  Fever 

they  have  never  forgotten  that  a  foreign 
protein  is  a  food  or,  perhaps,  an  enemy, 
to  be  spht  up  and  decomposed  at  sight.  So, 
the  epitheUal  cells  of  the  mucous  membrane 
of  the  nose  and  eyes,  though  they  have  no 
longer  anything  to  do  with  digesting  our 
food,  secrete  a  ferment  or  enzyme  that  can 
split  up  any  protein  that  may  happen  along. 
This  process  is  called  parenteral  digestion 
or  digestion  outside  of  the  intestines;  and 
this  theory  of  the  parenteral  digestion  of 
protein  is  the  foundation  of  the  anaphy- 
laxis theory  of  hay  fever. 

During  the  growing  months  of  the  year 
the  air  is  full  of  pollen  that  is  blown  in 
everybody's  eyes  and  nose.  In  that  pollen 
is  a  proteid  that  is  digested  by  the  secretion 
of  those  mucous  membranes,  proceeding 
exactly  as  food  is  digested  in  the  stomach 
and  intestines,  splitting  up  the  complex 
proteid  molecule  into  simpler  groups,  and 
forming  both  poisonous  and  non-poisonous 
substances.  In  the  normal  eyes  and  nose  this 
splitting  of  the  protein  proceeds  slowly, 
forming  only  minute  amounts  of  poison. 
As  absorption  from  the  eyes  and  nose  is 
slight,   no  unpleasant  efTects  are  produced. 


Hay  Fever  as  Anaphylaxis  83 

The  first  step  in  the  development  of  hay 
fever  is  supposed  to  be  a  disturbance  in  this 
digestion  of  protein  in  the  eyes  and  nose, 
by  which  larger  amounts  of  poison  are 
formed  and  absorbed  by  the  mucous  mem- 
brane, producing  the  first  poisoning,  which, 
like  the  first  injection  into  the  dog,  sensi- 
tizes the  mucous  membrane  to  other  doses 
of  the  same  poison.  It  is  supposed  that 
disturbance  in  the  protein  digestion  may  be 
caused  by  stoppage  of  the  nasal  passages, 
with  excessive  accumulation  of  proteid,  in- 
halation of  excessive  amounts  of  pollen, 
forming  excessive  amounts  of  poison,  or, 
perhaps,  insufiicient  secretion,  so  that  the 
splitting-up  process  is  not  hastened  to  its 
conclusion  of  harmless  products.  The  ana- 
phylaxis theory  halts  a  Httle  at  this  point 
and  is  not  exactly  clear  about  the  mechanism 
of  that  first  poisoning. 

After  the  first  poisoning,  the  epitheHa 
are  permanently  injured  and  remain  more 
permeable  to  protein.  They  also  develop 
the  power  of  making  large  amounts  of  the 
digesting  enzyme,  which  is  absorbed  into 
the  blood  and  is  supphed  to  all  the  tissues  of 
the  body,  so  that  all  tissues,  including  the 


84  The  Treatment  of  Hay  Fever 

skin,  can  decompose  the  pollen  protein. 
Advantage  is  taken  of  this  distribution  of 
the  protective  enzyme  in  the  skin  reaction, 
in  which  a  small  area  of  skin  denuded  of 
its  superficial  epithelia  reacts  in  the  form  of 
a  hive-like  swelling  when  the  pollen  that 
originally  affected  the  patient  is  brought  in 
contact  with  it. 

The  next  time  that  the  pollen  reaches 
the  eyes  and  nose  the  mucous  membrane 
is  ready  for  it  with  an  abundant  secretion 
of  enzymes  to  destroy  it.  In  this  intense 
digestion  of  the  proteid,  cjuantities  of  the 
poisonous  substances  are  formed  which  ir- 
ritate the  eyes  and  nose  worse  than  before, 
explaining  why  hay  fever  becomes  worse 
with  successive  attacks. 

The  inherited  form  of  hay  fever  is  ex- 
plained by  the  well-known  transmission  of 
anaphylaxis  to  the  offspring.  The  first  case 
in  the  line  of  descent  must  start  with  a 
severe  poisoning  that  lays  the  foundation 
of  the  anaphylactic  inheritance. 

I  would  submit  to  the  enthusiastic  im- 
munologist  that  this  first  sensitization  which 
he  takes  for  granted  but  cannot  prove  is 
the  weak  spot  in  his   hypothesis.     This  is 


Hay  Fever  as  Anaphylaxis  85 

the  point  where  he  needs  help,  and  it  is  at 
just  this  point  that  de  Mussy's  neglected 
theory  of  gout  completes  the  picture.  The 
immunologist  has  not  explained  why  I,  a 
boy  growing  up  with  other  boys,  inhaling  the 
same  amounts  of  pollen  as  they,  catching 
no  more  colds  than  they,  and  never  having 
any  serious  illness,  became  sensitive  to 
pollen  while  the  others  did  not.  There  is 
no  recollection  of  any  "first  poisoning"  by 
pollen  that  might  have  started  the  anaphy- 
laxis. But,  says  the  immunologist,  it  was 
your  parents  who  were  sensitized  and  you 
inherited  the  anaphylaxis.  Now,  my  parents 
lived  to  old  age  and  had  no  sign  of  hay  fever, 
though  my  brother  had  it  and  my  children 
are  beginning  to  sneeze  and  rub  their  eyes 
suspiciously  in  June  and  August.  But  if  you 
associate  hay  fever  with  the  gouty  diathesis, 
as  the  clinical  histories  seem  to  justify,  you 
enlarge  immensely  your  opportunity  to  prove 
ancestral  sensitization  to  whatever  unknown 
poison  originally  produced  the  gouty  sen- 
sitization. This  view  does  not  restrict  you 
to  ancestral  hay  fever,  but  extends  it  to 
gout  or  to  any  equivalent  of  gout. 

The  best  work  in  English  on  hay  fever  as 


86  The  Treatment  of  Ilay  Fever 

an  anaphylaxis  is  the  monograph  of  Karl 
K.  Koessler  in  Forchheimer's  Therapeusis 
of  Internal  Disease,  1914,  Volume  5,  page 
671,  to  which  the  reader  is  referred  for  a 
full  discussion  of  the  subject.  The  same 
author  gives  an  abstract  of  his  work  in  the 
Illinois  Medical  Journal,  1914,  page  120. 
This  article  in  Forchheimer  is  the  most 
complete  that  has  been  written  since  Sticker's 
time  and  covers  the  ground  from  Sticker, 
who  knew  not  anaphylaxis,  to  Wolff-Eisner, 
who  is  not  available  in  Enghsh. 

I  was  gratified  to  find  in  Koessler  a  sym- 
pathetic soul.  He  thinks,  as  I  did,  that 
the  monograph  of  Sticker  in  Nothnagel  is 
the  best  review  of  hay  fever  that  we  have. 
He  calls  it  "a  remarkable  monograph  and 
the  standard  work  on  the  subject."  But 
why,  oh  why,  K.  K.  K.,  in  your  own  mas- 
terly article  in  Forchheimer,  did  you  follow 
Sticker  all  through  his  historical  chapter 
but  leave  out  all  that  he  says  of  de  Mussy's 
theory  of  gout  or  arthritism  as  the  con- 
stitutional basis  of  hay  fever  and  also  leave 
de  Mussy  and  ever>^  reference  to  his  work 
out  of  your  list  of  Literature?  The  Ger- 
man books  are  more  liberal.     While  most  of 


Hay  Fever  as  Anaphylaxis  87 

them  ignore  de  Mussy  and  his  theory  in 
their  text,  they  all  hst  his  writings  in  the 
Literatur.  Has  the  microbe  of  bacteriology 
and  the  laboratory  bitten  you  so  virulently 
that  you  can  find  no  place  for  the  gouty 
diathesis  even  in  an  index? 

I  know  that  the  gouty  diathesis  is  out 
of  date.  In  fact,  all  diatheses  are  out  of 
fashion.  Nobody  speaks  of  them  now.  They 
went  out  with  the  medical  philosophies  of 
the  eighteenth  century.  Cellular  pathology 
with  its  wonderful  revelation  of  the  ana- 
tomical seat  of  disease  and  bacteriology, 
with  its  still  more  wonderful  revelation  of 
the  external  cause  of  disease,  so  dazzled  the 
eye  and  the  mind  that  we  forgot  that  the 
sensitive  animal  body  behind  the  attacking 
microbe  had  its  changes,  too,  its  changes  in 
body  chemistry  that  could  not  be  stated  in 
terms  of  cells  and  bacteria.  The  pendulum 
is  swinging  back  now  to  a  consideration  of 
the  constitution  of  the  body  on  which  the 
microbe  or  poison  acts,  its  resistance  or 
immunity,  its  anaphylaxis  or  allergie.  With 
these  hohday  and  lady  terms,  are  we  not 
trying  to  describe  what  our  ancestors  knew 
as  diathesis?     For  what  is  the  old  concep- 


88  The  Treatment  of  Hay  Fever 

tion  of  diathesis  but  just  such  a  hereditary 
weakness  or  lack  of  defense  or  tendency  to 
disease  that  our  ancestors  recognized  cHni- 
cally  but  could  not  demonstrate,  elusive, 
difficult  to  detect,  but  nevertheless  there; 
like  the  dog  who  has  been  sensitized  to  an 
otherwise  harmless  proteid,  who  seems 
well  and  is  well  in  everything  except  his 
susceptibility  to  that  one  special  cause  of 
disease? 

Bacteriology,  which  first  took  away  the 
idea  of  diathesis,  is  now  giving  it  back. 
The  discovery  of  the  tubercle  bacillus  as 
the  cause  of  tuberculosis  banished  the  tuber- 
cular diathesis  api)arcntly  forever;  but,  step 
by  step,  through  bacteria  and  then  toxins 
and  antitoxins  and  now  through  anaphy- 
laxis and  allergic,  bacteriology  is  bringing 
back  the  old  conception  of  an  inherited  or 
acquired  susceptibility  to  attack.  Call  the 
old  tubercular  diathesis  a  sensitization  and 
you  have  made  it  the  most  modern  of 
modern  discoveries.  So,  also,  step  by  step, 
through  bacteriology  with  its  toxins  and  an- 
titoxins and  now  with  anaphylaxis,  from  the 
philosophic  ash-heap  on  which  we  thought 
to    have    thrown    it    for  good  and  all,   like 


Hay  Fever  as  Anaphylaxis  89 

an  old  family  cat  that  we  thought  was  dead, 
comes  creeping  back  that  old  conception  of 
a  gouty  diathesis  or  arthritism,  not  as  dead 
as  we  thought  it,  to  complete  the  explana- 
tion of  the  existence  of  hay  fever. 

I  am  far  from  saying  that  calling  hay  fever 
a  form  of  gout  ends  the  subject.  I  say  only 
that  bringing  such  a  common  and  puzzling 
disorder  as  hay  fever  in  line  with  such  a 
common  and  puzzling  disorder  as  gout  brings 
us  a  long  step  nearer  to  solving  the  puzzle 
that  lies  behind  both  of  them;  and  I  say 
also  that,  in  the  records  of  this  work,  the 
name  of  Gueneau  de  Mussy,  who  first 
recognized  this  relation  clinically,  deserves 
a  place. 

Gout  as  an  anaphylaxis,  hay  fever  as  an 
external  expression  of  gout,  what  a  vista 
of  therapeutic  possibilities  is  opened  up  by 
these  simple  experiments  with  pollen  ex- 
tracts and  foods.  The  subject  ramifies  in 
every  direction,  touching  the  gouty  form  of 
Bright's  disease,  gouty  heart  disease,  endo- 
carditis and  pericarditis,  the  popular  "hard- 
ening of  the  arteries,"  which  may  prove 
after  all  not  to  be  due  to  meat  in  all  cases 
or  alcohol  in  all  cases  but  certain  foods  in 


9©  The  Treatment  of  Hay  Fever 

certain  cases,  the  increase  in  deaths  from 
heart  disease  and  kidney  disease  in  the 
fifth  decade  of  Hfe.  The  correlation  of 
these  gouty  problems  with  this  work  in  the 
prevention  and  cure  of  hay  fever  anaphy- 
laxis awaits  a  Lister  or  a  Pasteur  or  a  Koch 
who  will  have  an  eye  to  see  and  a  patient 
industry  to  search  and  find. 

When  you  have  established  hay  fever  as 
anaphylaxis  or  lowered  resistance  to  a 
specific  proteid,  you  may  be  sure  that  the 
immunologist  will  seize  the  patient  as  his 
own,  carry  him  ofl  to  the  laboratory,  and 
there  attempt  to  raise  his  resistance  or  de- 
velop immunity  to  the  attacking  proteid 
by  giving  minute  doses  of  the  poison 
gradually  increased.  The  success  of  this 
procedure  will  be  related  in  the  next  chapter. 


CHAPTER  XI 
IMMUNIZING  WITH  POLLEN  EXTRACT 

The  idea  of  preventing  disease  and 
poisoning  by  preparing  the  body  with  mi- 
nute doses  of  that  poison,  gradually  increas- 
ing until  the  body  is  immune,  is  an  ancient 
one.  The  practice  is  Ur-alt,  as  my  favorite 
German  history  books  say;  for  it  has  been 
found  among  savages  and  primitive  peoples 
and  is  practised  in  a  crude  way  by  every 
boy  who  accustoms  himself  to  that  noxious 
weed,  tobacco.  Then,  there  are  the  Psylli, 
whom  Lucan  tells  of,  who  were  by  heredity 
immune  to  snake  poison  and  who  could 
make  the  favored  stranger  immune  by  in- 
oculating him  with  small  doses  (Pharsalia, 
Book  ix);  and  old  King  Mithridates,  of 
Pontus,  who  believed  in  preparedness  and 
kept  himself  prepared  for  the  attentions 
of  his  faithful  subjects  by  taking  small  doses 
of  poison  every  day,  keeping  himself  im- 
mune should  by  any  accident  some  poison 
slip  into  his  porridge  {Pliny,  Book  xxv). 
Old  King  Mithridates  was  a  good  immunol- 
ogist.      He   knew   the   transient   nature   of 


92  The  jyeatmcnt  of  Hay  Fever 

immunity  and  kept  the  treatment  up.  He 
knew  that,  if  he  stopped  taking  the  poison 
for  a  week  or  so,  he  would  go  into  a  state  of 
anaphylaxis  and  the  next  dose  would  kill 
him;  so  he  kept  himself  in  a  state  of  anti- 
anaphylaxis  by  not  permitting  too  long  a 
time  to  elapse  between  doses,  after  the  most 
approved  rules  of  modern  immunology. 
That  patient  whom  Goodale  immunized 
against  horse-asthma  who  objected  to  a 
treatment  that  had  to  be  taken  for  the  rest 
of  her  life,  should  learn  of  old  King  Mithri- 
dates  the  true  practice  of  immunity. 

This  is  still  the  weak  point  of  artificial 
immunity;  it  does  not  last  very  long.  You 
can  immunize  a  guinea-pig  or  a  patient  to 
almost  anything  now-a-days  by  giving  him 
minute  doses  gradually  increased  but  the 
immunity  passes  off  quite  rapidly  when  the 
treatment  is  stopped.  We  have  still  some- 
thing to  learn  from  Nature  in  this  respect. 
Nature  can  give  us  one  dose  of  yellow-fever 
or  scarlet-fever  or  small-pox  or  measles 
and  make  us  immune  for  life  but  your  arti- 
ficially produced  immunity  may  last  for 
a  few  weeks  or  months  only.  Our  closest 
imitation  of  natural   immunity   is  vaccina- 


Immunizing  with  Pollen  Extract       93 

tion  against  small-pox.  Here  we  produce 
an  actual  disease,  cow-pox;  yet,  even  here, 
we  are  not  at  all  sure  how  long  immunity 
lasts.  Even  in  Jenner's  time,  the  original 
belief  in  protection  for  life  came  down  to 
seven  years  and  our  modern  health  boards 
would  vaccinate  every  two  years  or,  in  the 
presence  of  an  epidemic,  more  frequently. 

However,  Nature  is  a  wasteful  worker, 
wasteful  of  her  material,  and  she  kills  a 
great  many  of  her  children  with  measles 
and  scarlet-fever  and  small-pox  and  yellow- 
fever  while  immunizing  the  lucky  ones. 
A  Health  Board  that  would  kill  so  many 
people  while  immunizing  the  rest  would 
be  a  public  scandal.  Yet  it  is  probable 
that  Nature's  way  is  the  most  effective  and 
that  the  best  immunizer  is  the  disease  it- 
self, as  Koch  found  with  tuberculosis  among 
his  guinea-pigs  that  the  best  protection 
against  tuberculosis  was  inoculation  with 
Hving  tubercle  bacilli,  not  with  dead  ones; 
and  the  autopsies  show  that  the  majority 
of  the  human  race  that  grow  up  at  all  have 
been  successfully  immunized  against  tubercu- 
losis by  a  mild  local  attack  of  the  disease. 

As  yet,  no  one  has  had  the  boldness  to 


94  ^  ^^6  Treatment  oj  Ilay  Fever 

inoculate  human  brings  with  hving  bac- 
teria and  to  imitate  Nature  in  her  manner 
of  kiUing  off  all  the  sensitive  subjects  in 
order  to  preserve  the  rest.  This  was  for- 
merly done  by  inoculation  with  small-pox 
but  the  unfortunate  results  of  the  practice 
compelled  its  abandonment  among  civilized 
people.  Even  Nature's  immunity  is  not 
perfect  in  all  diseases,  as  many  a  patient 
with  his  sixth  attack  of  grippe  or  third 
pneumonia  or  fortieth  year  of  hay  fever 
has  learned  most  feelingly;  and  this  ir- 
regularity of  natural  immunity  bears  di- 
rectly on  the  proposal  to  immunize  patients 
against  hay  fever  by  small  and  increasing 
doses  of  the  offending  pollen.  If  the  natural 
disease  does  not  confer  lasting  immunity, 
you  will  have  some  difficulty  in  conferring 
lasting  immunity  artificially,  as  the  im- 
munologist  is  just  now  discovering.  His 
immunity  passes  off  so  rapidly  that  he  is 
now  searching  for  a  method  of  immuniz- 
ing that  can  be  carried  on  for  many  years 
without  tying  the  patient  to  a  laboratory  for 
life.  It  is  right  here  that  I  believe  that 
homcropathy  lias  \'aluable  methods  that 
can  be  applied  to  the  situation. 


Immunizing  with  Pollen  Extract       95 

But  we  must  not  jump  to  conclusions. 
Because  we  can  immunize  successfully 
against  one  disease,  it  does  not  follow  that 
the  same  methods  will  immunize  against 
another  disease.  Each  disease  is  a  problem 
in  itself  and  may  require  its  own  methods. 
Nor  because  we  can  immunize  the  guinea- 
pig  in  the  laboratory,  does  it  follow  that  the 
same  methods  are  appHcable  in  the  human 
patient.  The  only  proof  that  we  can  inunu- 
nize  against  hay  fever  is  to  immunize  against 
hay  fever.     So,  to  the  subject! 

Passive  Immutiny.  The  first  man  to 
attempt  to  apply  the  methods  of  modern 
immunity  to  hay  fever  was  Dunbar,  of 
Hamburg,  in  1903,  with  this  pollantin. 
He  attempted  to  duplicate  in  hay  fever 
the  triumph  of  antitoxin  in  diphtheria 
by  injecting  a  horse  with  increasing  doses 
of  pollen  until  the  horse  became  immune 
to  large  doses  of  pollen  and  his  blood  full 
of  antibodies.  Dunbar  expected  to  confer 
passive  immunity  on  the  hay  fever  patient 
by  transferring  to  him  this  horse  serum 
with  its  antibodies.  There  is  no  better 
example  of  the  rule  that  each  disease  re- 
quires its  own  methods  of  irmnunity.    While 


96  The  Treatment  of  Hay  Fever 

diphtheria  antitoxin  is  harmless  to  the 
diphtheria  patient,  the  serum  of  the  pollen- 
immunized  horse  nearly  killed  the  first 
patient  Dunbar  tried  it  on,  who  happened 
to  be  his  assistant,  a  sufferer  from  hay 
fever.  It  is  probable  that  pollantin  is 
based  on  the  wrong  principle,  that  hay 
fever  is  not,  like  diphtheria,  a  poisoning 
by  a  toxin  to  be  antidoted  by  an  antitoxin, 
However,  to  Dunbar  belongs  the  credit 
of  first  attempting  to  put  the  treatment 
of  hay  fever  on  a  scientific  basis  and  he  in- 
troduced the  method  of  testing  the  patient 
that  has  been  followed  by  all  later  workers, 
dropping   the  pollen   extract   in   the  eye. 

Inthe  Centralhlatt  fiir  Baklcriologie,  Re- 
fer ate,  XXX vi,  s.  453,  there  is  an  account  of 
a  most  unseemly  quarrel  between  Dun- 
bar and  Weichardt,  the  latter  claiming 
that  before  leaving  Hamburg,  he  suggested 
the  idea  of  pollantin  to  Dunbar.  Weichardt 
has  since  put  on  the  market  another  hay 
fever  specific,  called  gramifwl,  which  is  the 
blood-serum  of  cattle  that  have  fed  on  the 
offending  grasses  during  the  hay  fever 
season.  The  theory  is  that  the  blood  of 
the  cow  contains  antibodies  to  those  grasses 


Immunizing  with  Pollen  Extract       97 

and  that  passive  immunity  can  be  con- 
ferred on  the  hay  fever  patient  by  trans- 
ferring those  antibodies  to  his  blood. 

This  is  the  old,  old  experiment  that  has 
been  tried  so  many  times  in  many  diseases 
and  has  so  often  failed.  It  reminds  us  of 
the  many  attempts  to  confer  on  the  tuber- 
culosis patient  the  natural  immunity  pos- 
sessed by  the  jackass  by  injecting  the  patient 
with  the  blood  serum  of  that  friend  of  man. 
The  result  of  these  experiments  left  some 
doubt  as  to  who  merited  most  the  name 
of  jackass,  the  doctor,  the  patient  or  the 
patient  beast.  Both  poUantin  and  grami- 
nol  have  been  praised  highly  in  Germany 
but  neither  of  them  have  succeeded  so 
well  in  this  country.  Perhaps  a  shrewd 
advertising  campaign  had  something  to  do 
with  it;  for  the  combination  of  a  German 
scientist  and  his  manufacturer  can  give 
points  to  any  Yankee  in  exploiting  the 
pubhc  with  sure  cures  for  the  sick. 

Active  Immunity.  In  active  immuni- 
zation, the  real  pioneers,  after  Mithri- 
dates,  were  the  homoeopaths,  who,  for 
many  years,  have  given  small  doses  of  poison 
ivy    to    prevent    ivy   poisoning    and    small 


98  The  Treatment  of  Hay  Fever 

doses  of  the  poisons  of  infectious  diseases 
to  prevent  and  cure  those  diseases;  but 
the  homoeopath  did  not  reahze  the  transient 
nature  of  immunity  and  the  necessity  for 
continuing  the  treatment  for  many  months 
or  years,  nor  did  he  adopt  the  principle 
of  increasing  the  dose  to  the  point  of 
toleration. 

The  first  to  attempt  active  immuniza- 
tion and  cure  of  hay  fever  by  injecting 
extracts  of  the  pollen  that  causes  the  dis- 
ease appears  to  have  been  Noon,  work- 
ing in  Wright's  laboratory  in  London.  The 
work  was  continued  by  Freeman,  their 
work  being  reported  in  the  Lancet,  191 1, 
i,  page  1572  and  ii,  page  814.  They  found 
the  English  spring  form  of  hay  fever  due 
to  the  pollen  of  grasses.  By  dropping 
extracts  of  various  pollens  into  the  pa- 
tient's eye,  after  the  manner  of  Dunbar, 
they  concluded  that  their  patients  were 
most  sensitive  to  timothy  grass  and  they 
used  timothy  extract  exclusively  in  the 
treatment.  Freeman  states  explicitly  that 
a  patient  immunized  against  timothy  grass 
is  immune  to  all  other  grasses  of  that 
season;    that  it  is  unnecessary  to  immunize 


Immunizing  with  Pollen  Extract       99 

him  to  each  particular  grass,  thus  differing 
from  some  of  our  American  observers  who 
use  the  skin  reaction  to  determine  the 
particular  pollens  to  which  the  patient  is 
sensitive  and  inject  every  one  of  those 
pollens    in    the    treatment. 

Independently  of  these  British  observers, 
Karl  Koessler,  of  Chicago,  in  1910,  at- 
tempted to  immunize  patients  against  hay 
fever  by  injecting  pollen  extracts.  Like 
Noon  and  Freeman,  he  used  the  eye  re- 
action to  test  his  patients  and  found  them 
most  sensitive  to  rag  weed.  Just  as  the 
EngHshmen  had  used  only  timothy  grass 
in  their  cases,  Koessler  used  rag  weed  ex- 
clusively. His  work  is  reported  in  his 
article  on  Hay  Fever  in  Forchheimer's 
Therapeusis,  Volume  V  and  also  in  the  Il- 
linois Medical  Journal,  1914,  page  120. 

Selecting  the  Pollen.  The  Skin  Reac- 
tion. The  next  step  in  the  development 
of  the  pollen  treatment  was  to  substitute 
the  skin  reaction  for  the  eye  reaction  in 
testing  the  patient's  sensitiveness  to  various 
pollens.  The  advantage  of  the  skin  reac- 
tion over  the  eye  reaction  is  that  it  permits 
testing  many  pollens  at  the  same  time  and 


loo         The  Treatment  of  Hay  Fever 

does  not  distress  the  patient  as  does  a  sharp 
eye  reaction. 

Wliile  Noon  and  Freeman  selected  the 
one  typical  pollen  of  spring,  the  timothy 
grass  pollen,  and  Koessler  selected  the 
typical  fall  pollen  of  the  American  hay 
fever,  rag  weed,  for  all  cases  of  that  season, 
later  workers,  using  the  skin  reaction,  go 
to  the  extreme  of  injecting  the  patient  with 
each  and  every  pollen  to  which  his  skin 
reacts.  Oppenhcimer  and  Gottlieb  carry 
this  individualization  to  the  point  of  at- 
tempting to  discriminate  by  the  skin  test 
the  patient's  varying  resistance  to  his  dif- 
ferent pollens  at  each  treatment.  This  re- 
sistance may  rise  for  some  and  fall  for  other 
pollens  so  that  six  or  eight  different  pollens 
in  different  doses  must  be  injected  sepa- 
rately at  each  treatment.  This  is  indi- 
vidualizing the  case  with  a  vengeance  and 
requires  an  expenditure  of  time  and  skill 
(I  almost  said  skin)  that  must  be  rather 
ex-pensive   for   the  patient. 

A  series  of  light  scratches  are  made  on 
the  skin  of  the  forearm  or  the  inner  side  of 
the  arm  where  the  skin  is  delicate.  The 
scratch   must   be   only   superficial   and   not 


Immunizing  with  Pollen  Extract      loi 

draw  blood.  Really  the  best  method  is  to 
make  a  round  denuded  spot  by  twirling 
a  small  brad-awl.  A  drop  of  extract  of 
different  pollens  or  a  speck  of  the  pure 
pollen  protein  is  rubbed  into  each  scratch 
and  the  result  awaited  for  fifteen  minutes. 
Within  that  time,  a  redness  and  swelling, 
like  a  hive  or  a  bite,  will  appear  at  some  of 
the  scratches. 

This  swelHng  is  the  skin  reaction  to  that 
pollen.  Its  appearance  indicates  the  pres- 
ence in  the  skin  of  reaction  bodies  to  that 
pollen.  It  is  argued,  and  partially  proved  by 
practice,  that  the  pollens  to  which  the  skin 
reacts  are  the  pollens  to  which  that  patient 
has  been  sensitized  and  these  pollens  are 
selected  for  administration. 

The  Dose.  The  first  dose  of  pollen  ex- 
tract is  the  danger  dose  and  differs  for 
each  patient  according  to  his  susceptibility 
for  a  given  pollen.  It  is  determined  by 
dropping  the  pollen  extract  into  the  eye  or 
rubbing  it  on  the  skin.  To  avoid  ana- 
phylactic shock,  this  dose  must  be  incredibly 
small.  Noon  and  Freeman's  first  dose  was 
one- third  c.  c.  of  the  weakest  dilution  of 
which  one  drop  in  the  eye  would  cause  hy- 


I02  The  Treatment  of  Hay  Fever 

peraemia.  This  was  usually  four  drops  of 
a  millionfold  dilution  in  water.  Later  doses 
were  never  more  than  i  c.  c.  of  a  i  to  100,000 
dilution    "to   avoid    unpleasant    reactions." 

Goodale  begins  with  five  drops  of  that 
dilution  that  just  fails  to  cause  a  skin  re- 
action. Later,  to  avoid  the  risk  of  shock, 
he  advises  one-tenth  of  this  dose. 

Koessler's  theoretical  initial  dose  of  rag 
weed  extract  is  one  drop  of  the  weakest 
dilution  that  will  just  redden  the  conjunc- 
tiva. As  he  finds  rag  weed  more  toxic  than 
the  English  timothy,  his  actual  first  dose  is 
one-half  of  this  theoretical  dose.  The  actual 
first  dose  will  vary  from  one  drop  of  a  i  to 
1,000,000  to  one  drop  of  a  i  to  20,000  dilu- 
tion, the  smaller  of  which  he  estimates  to 
contain  of  pollen  protein  one  one-hundredth 
part  of  a  millionth  of  a  gramme  or  .000,000,01 
gramme. 

Shade  of  Samuel  Hahnemann,  the  first 
and  greatest  homoeopath!  And  they  drove 
you  out  of  Leipzig  into  poverty  and  exile 
for  teaching  that  in  using  drugs  that  are 
similar  to  the  disease  there  is  serious  danger 
of  aggravating  the  disease;  that  the  dose 
must  be  extremely  small;    and  that  disease 


Immunizing  with  Pollen  Extract      103 

so  sensitized  the  patient  that  a  dose  so  small 
as  to  be  inappreciable  in  health  becomes 
active  in  disease! 

The  smaller  doses  of  pollen  extract  are 
given  every  three  or  four  days  and  increased 
as  rapidly  as  possible,  judging  the  increasing 
tolerance  or  resistance  by  a  diminishing 
eye  or  skin  reaction.  With  larger  doses, 
the  interval  is  longer,  a  week  or  ten  days. 
The  pioneer,  Noon,  and  all  workers  since, 
warn  against  increasing  the  dose  too  fast, 
for  the  reactive  power  of  the  patient  is 
easily  exhausted,  his  resistance  lowered  and 
he  may  be  left  more  sensitive  than  before. 

Dangers  of  Pollen  Injections.  Treat- 
ment by  pollen  injection  is  beset  with 
dangers  for  the  unlucky  patient.  It  has 
been  noted  how  Dunbar  nearly  killed  his 
first  patient  by  injecting  the  serum  of  the 
horse  that  had  been  immunized  to  pollen. 
All  experimenters,  without  exception,  say 
that  the  injection  of  pollen  extract  is  at- 
tended with  danger  to  the  patient,  danger 
of  anaphylactic  shock,  and  warn  against 
the  use  of  any  but  the  most  infinitesimal 
doses.  The  hay  fever  patient  is  a  human 
being  who,  in  some  way,  has  been  sensitized 


I04        'The  Treatment  of  Hay  Fever 

to  pollen.  He  is  in  a  state  of  exquisite 
anaphylaxis  and  a  dose  of  pollen  injected 
into  his  blood  may  kill  him  in  twenty  min- 
utes. Goodale  reports  shock  (faintness, 
nausea,  vomiting)  in  two  patients  follow- 
ing the  mere  rubbing  of  a  drop  of  pollen 
extract  into  a  scratch  on  the  skin.  Evi- 
dently the  scratch  was  too  deep  and  the 
pollen  poison  was  absorbed  rapidly  into  the 
blood  instead  of  being  stopped  by  the  deep 
epithelia.  I  have  seen  a  similar  absorp- 
tion and  general  reaction  in  children  after  a 
skin  test  with  tuberculin,  when  the  tuberculin 
entered  the  blood  through  too  deep  a  scratch. 
Another  danger  lies  in  the  instability 
of  the  pollen  extracts.  Koessler  expressly 
warns  against  commercial  preparations  of 
pollen  protein  because  of  the  danger  of 
decomposition.  His  extracts  do  not  keep 
more  than  three  weeks  and  are  dangerous 
to  use  after  that  time.  On  the  other  hand, 
Goodale,  making  his  extracts  with  15% 
alcohol,  reports  them  as  active  and  fit 
for  use  after  more  than  one  year.  Oppen- 
heimer  and  Gottlieb  object  to  commercial 
preparations  on  different  grounds.  The 
commercial  preparations  contain  many  differ- 


Immunizing  with  Pollen  Extract      105 

ent  pollens  so  as  to  be  sure  to  include  those 
to  which  the  patient  is  sensitive.  They 
point  out  that  in  these  mixtures,  the  dose  of 
the  individual  pollens  cannot  be  adjusted  to 
the  changing  conditions  of  the  patient  and, 
in  addition,  injecting  into  the  blood  of  the 
patient  pollens  to  which  he  is  not  already- 
sensitive  may  sensitize  him  to  these  pollens 
also  and  leave  him  worse  than  before. 

There  is  the  lesser  danger  that  the  patient 
will  not  be  immunized  by  the  injections 
but  become  more  sensitive  to  his  old  pollens 
than  he  was  before,  as  Noon  pointed  out 
in  his  first  paper;  for  artificial  immunity 
is  a  difficult  thing  to  control  and  is  by  no 
means  as  easy  as  it  looks  in  the  book.  Nor 
is  it  as  easy  to  immunize  a  human  being 
over  many  years  of  fife,  subject  to  so  many 
conflicting  influences,  as  it  is  to  immunize 
a  guinea-pig  living  in  a  cage. 

To  lessen  the  dangers  and  enable  the 
patient  to  keep  up  his  immunization  for 
many  months  and  years,  Goodale  borrowed 
an  idea  from  Schloss,  who  fed  his  egg-oat- 
meal-almond anaphylaxis  patient  minute 
doses  of  these  foods  until  he  so  raised  his 
resistance  that  he  was  able  to  eat  them  in 


io6         The  Treatment  of  Ilay  Fever 

ordinary  quantities  without  harm.  Such 
artificial  resistance  must  be  kept  up  by  eat- 
ing a  small  quantity  of  the  food  each  day 
or  it  will  be  lost  (old  King  Mithridates 
again).  As  most  of  the  pollens  are  not 
edible  and  as  patients  react  to  botanically 
allied  plants,  Goodale  tried  feeding  the 
patient  over  long  periods  of  time  with 
vegetables  and  edible  plants  that  were 
allied  to  the  offending  pollens,  expecting 
that,  as  in  Schloss's  patient,  some  minute 
part  of  the  protein  would  pass  unto  the 
blood  unchanged  and  maintain  the  pro- 
tection. So  far,  these  feeding  experiments 
have  failed.  Trial  with  homoeopathically 
potentized  pollens  over  long  periods  of  time 
has   not  been   made. 

Conclusions  on  Pollen  Extracts.  My 
conclusions  on  the  pollen  treatment  are  that 
it  is  in  line  with  our  best  practice  of 
immunity  but  that  it  is  still  in  an  exper- 
imental stage,  the  pollens  are  possibly 
dangerous  even  in  the  hands  of  a  skilled 
immunologist.  In  a  disease  that  is  usually 
so  easily  controlled  by  rosin-weed,  faradism 
and  ichthyol,  I  would  not  expose  a  hay  fever 
patient  to  the  very  real  danger  of  anaphyl- 


Immunizing  with  Pollen  Extract      107 

actic  shock.  The  conditions  governing  im- 
munity stated  in  the  beginning  of  this  chapter 
still  hold  good.  It  is  transient.  Already  some 
of  the  early  workers  have  discontinued  the 
practice.  The  despair  of  Goodale  has  been 
quoted.  Scheppegrell,  probably  the  first 
in  this  country  to  use  the  pollens,  has  given 
them  up  and  advises  the  patient  to  keep 
away  from  his  irritant  and  to  have  the 
weeds  cut  in  all  cities  as  the  best  treatment 
obtainable  {Journal  of  the  A.  M.  A.,  March 
4,  1 916,  page  710).  The  most  hopeful 
aspect  of  the  pollen  extracts  seems  to  me 
to  be  their  administration  all  around  the 
year  in  high  dilutions,  more  homoeopathico^ 
and  to  this  practice  I  believe  the  immunol- 
ogist  will  eventually  come. 

Pollen  Extracts  not  Vaccines.  Some 
manufacturers  and  all  British  writers  speak 
of  pollen  extracts  as  vaccines  and  of  im- 
munizing the  patient  as  vaccination.  This 
seems  an  unnecessary  confusion.  We  have 
two  kinds  of  vaccines  already,  the  cow-pox 
vaccine  and  the  killed  cultures  of  bacteria 
introduced  by  Wright.  For  an  account  of 
the  use  of  these  vaccines  in  hay  fever,  we 
will  pass  to  the  next  chapter. 


CHAPTER   XII 
THE  BACTERIAL   VACCINES 

In  his  paper  in  The  Lancet,  the  pioneer 
in  the  use  of  pollen  extracts,  Freeman, 
observed  that  "many  cases  of  supposed  hay 
fever"  were  simply  acute  bacterial  catarrhs. 
He  excluded  hay  fever  by  the  lack  of  any  re- 
action when  timothy  extract  was  dropped 
into  the  eye.  The  bacterial  infection  was 
proved  by  culture  from  the  eyes  and  nose, 
usually  yielding  the  staphylococcus.  The 
final  proof  was  the  cure  of  the  patient  by 
an  autogenous  vaccine  made  of  the  offend- 
ing microbe.  In  the  past  few  years,  this 
observation  has  been  confirmed  and  many 
cases  of  cure  of  "hay  fever"  by  bacterial 
vaccines  have  been  reported  in  the  journals. 
The  bacteria  were  chiefly  staphylococci, 
rarely  the  pneumococcus  or  the  micrococcus 
catarrhalis. 

Oppenheimer  and  Gottlieb  report  cases 
of  mixed  hay  fever  where  the  skin  reacts 
to  pollen  but  the  pollen  extract  failed  to 
cure.  In  these  cases,  they  found  a  bac- 
terial catarrh  of  the  eyes  and  nose.    They 


The  Bacterial  Vaccines  109 

suppose  a  vicious  circle,  the  catarrhal  in- 
flammation and  the  hay  fever  sensitiveness 
mutually  interfering  with  each  other's  re- 
covery and  they  succeeded  in  curing  the 
patient  by  using  the  appropriate  pollen 
extract  and  the  bacterial  vaccine  at  the 
same  time,  believing  that  while  the  pollen 
extract  was  raising  resistance  to  the  pollen 
poisoning,  the  bacterial  vaccine  was  rais- 
ing resistance  to  the  bacterial  catarrh. 

While  hay  fever  is  not  strictly  a  catarrhal 
inflammation,  the  cure  of  hay  fever  by 
curing  a  coexisting  catarrhal  rhinitis  or  con- 
junctivitis seems  easily  possible.  The  sur- 
geons taught  us  long  ago  that  some  cases 
of  "hay  fever"  need  nothing  but  good 
drainage  of  the  nose,  which  they  secured 
by  freeing  the  nose  from  obstruction.  Every 
physician  sees  mild  cases  of  hay  fever  re- 
cover on  various  popular  catarrh  treatments. 
The  tablets  sold  by  homoeopathic  pharmacies, 
containing  iodide  of  arsenic,  naphthalin  and 
quillaya,  cure  many  cases  of  hay  fever  and 
these  are  the  same  drugs  that  cure  catarrhal 
rhinitis.  It  is  easily  possible  that  my  old 
inheritance,  rosin  weed,  cures  hay  fever  by 
curing  the  coexisting  catarrh;    for  it  was  a 


no         The  Treatment  of  II ay  Fever 

famous  remedy  among  the  eclectics  for 
catarrhal  inflammation  of  the  nose,  throat 
and  bronchial   tubes. 

If,  then,  operations  or  remedies  that  cure 
catarrhal  rhinitis  cure  also  some  cases  of 
hay  fever,  there  is  nothing  inherently  im- 
probable in  ex]3ecting  the  bacterial  vaccines 
to  cure  some  cases  of  hay  fever,  for  the 
vaccines  have  made  many  cures  of  catarrhal 
inflammation.  However,  the  physician  using 
them  should  understand  that  they  are  not 
specific  drugs  against  the  pollen  anaphyl- 
axis but  against  a  supposed  catarrh  or  bac- 
terial infection.  He  will  be  well  advised 
to  control  the  treatment  by  taking  cultures 
from  the  nose  to  make  sure  that  the  bac- 
teria are  there,  determine  the  variety 
present  and,  if  possible,  have  an  autog- 
enous vaccine  made  up  for  treatment. 

I  have  no  personal  experience  with  the 
vaccines  in  the  treatment  of  hay  fever, 
though  I  know  their  value  in  ordinary 
catarrhal  conditions.  .\s  remarked  in  the 
chapter  on  Pollens,  I  have  succeeded  with 
the  milder  methods  of  rosin-weed,  faradism 
and  ichthyol.  However,  bacterial  vaccines 
are   much   safer   than   pollen    extracts,    the 


/ 


The  Bacterial  Vaccines  1 1 1 

technique  of  their  use  is  not  as  compHcated 
and  they  are  well  worthy  of  trial  in  re- 
fractory cases  if  bacteria  are  demonstrated 
in  the  eyes  and  nose.  I  might  remark  here 
that  this  demonstration  will  seldom  fail; 
for  you  can  get  a  culture  of  the  staphylo- 
coccus from  almost  any  nose. 

The  Word  Vaccine.  Used  in  connec- 
tion with  the  treatment  of  hay  fever,  the 
word  vaccine  is  confusing,  for  it  has  been 
applied  to  two  totally  different  kinds  of 
medicine,  the  bacterial  vaccines  and  the 
pollen  extracts.  Physicians  intending  to 
use  vaccines  in  the  treatment  of  hay  fever 
should  make  sure  which  they  are  using;  for 
the  methods  and  dosage  of  the  one  are  quite 
different  from  those  of  the  other.  Sir  Alm- 
roth  Wright,  to  whom  the  whole  world  is 
indebted  for  his  work  in  preventive  medi- 
cine, started  the  trouble  by  calling  his 
killed  bacteria  vaccines,  having  in  mind 
the  prevention  of  bacterial  diseases  as  the 
famiUar  vaccine  prevented  small-pox.  Now, 
vacca  is  Latin  for  cow,  vaccinia  is  properly 
cow-pox  and  the  virus  of  cow-pox  that  we 
use  in  vaccination  against  small-pox  is 
properly    called    vaccine.    With    a    paucity 


112         The  Treatment  of  Hay  Fever 

of  vocabulary  unexpected  in  an  Irishman, 
Wriglit  called  his  killed  bacteria  vaccines 
because  he  used  them  to  prevent  disease, 
using  the  word  as  synonymous  with  pre- 
ventive. As  cow-pox  vaccine  is  the  greatest 
preventive  we  know,  the  word  vaccine  might 
be  justified  when  applied  to  the  bacterial 
cultures  or  to  the  pollens  or  to  any  pre- 
ventative of  disease.  But  when  you  leave 
pure  prevention  and  apply  these  remedies 
to  the  cure  of  disease,  the  word  vaccine  loses 
even  this  shadow  of  justification  and  the 
present  confusion  results.  One  American 
house  makes  a  laudable  attempt  at  a  more 
exact  terminology^  by  calling  the  killed 
cultures  of  bacteria  bacterins.  Still,  the 
word  vaccine  for  killed  bacterial  cultures 
has  been  advertised  so  deeply  into  the  medi- 
cal mind  that  it  is  firmly  rooted  there  and 
not  likely  to  be  disturbed  by  mere  consid- 
erations of  etymolog}'.  As  for  the  pollen 
extracts,  they  are  yet  young  and  impres- 
sionable. It  would  be  better  to  leave  off 
the  word  vaccine  as  applied  to  them  and 
call  them  what  they  are,  pollen  extracts. 


CHAPTER  XIII 
DIET 

Until  recently,  diet  in  hay  fever  was  a 
matter  of  avoiding  meat  and  strawberries 
and  the  result  was  usually  unsatisfactory. 
With  the  conception  of  hay  fever  as  an  ana- 
phylaxis and  the  recent  studies  in  food 
anaphylaxis,  the  subject  of  diet  in  hay  fever 
assumes  a  new  and  inviting  aspect. 

This  new  view  of  diet  in  hay  fever  begins 
with  Schloss's  masterly  study  of  a  case  of 
food  anaphylaxis  reported  in  the  American 
Journal  on  Diseases  of  Children,  191 2,  No.  6. 
A  good  review  of  the  subject  with  references 
to  the  literature  will  be  found  in  the  special 
Hay  Fever  and  Anaphylaxis  number  of  the 
Boston  Medical  and  Surgical  Journal,  August 
10,  1916,  especially  the  article  by  Talbot. 

Some  physicians  have  long  insisted  that 
they  could  relieve  hay  fever  by  diet.  For 
instance,  I  once  asked  a  physician  of  large 
general  practice  what  he  did  for  hay  fever. 
He  smiled  in  an  incredulous  way  that  I 
have  noticed  before  among  people  who 
never  had  hay  fever  and  replied,  "I  find  that 


1 14         The  Treatment  of  Hay  Fever 

if  people  will  stop  eating  strawberries  and 
not  eat  too  much  meat,  they  soon  get  rid 
of  their  hay  fever."  This  answer  surprised 
me  for  I  knew  that  in  his  long  practice,  he 
must  have  seen  many  cases  of  hay  fever 
and  my  experience  had  been  that  diet  had 
no  influence  on  the  symptoms. 

Then,  there  is  Professor  Dunn,  already 
quoted  in  Chapter  IX,  who  believes  in 
the  uric  acid  theory  and  says  that,  in  his 
opinion,  "hay  fever  is  the  result  of  improper 
eating  and  living."  He  has  been  able  to 
prevent  the  annual  attacks  by  using  cold 
baths  and  excluding  meat,  tea,  coffee  and 
alcohol  from  the  diet. 

Any  patient  who  can  get  rid  of  the  annoy- 
ing symptoms  of  hay  fever  by  such  simjile 
means  of  diet  and  bathing  should  be  urged 
to  try  it,  whether  he  believes  or  disbelieves 
in  the  "uric  acid  poisoning"  on  which  the 
treatment  is  based.  My  own  exj^erience 
leads  me  to  believe  that  most  hay  fever 
patients  require  something  more  than  diet- 
ary regulation  to  control  the  disease.  For 
instance,  in  my  own  case,  the  disease  ap- 
peared at  an  age  when  I  had  never  taken 
tea,   coffee  or  alcohol,   during   the  summer 


Diet  115 

vacation  when  I  was  living  a  hygienic  out- 
door Ufe,  playing  ball,  cycling  and  swim- 
ming every  day  in  the  salt  water.  I  re- 
member one  summer  in  camp  by  a  lake 
among  the  pines,  in  which  I  lived  Dr.  Dunn's 
hygienic  Hfe  for  many  weeks,  drinking  no 
tea,  coffee  or  alcohol,  eating  chiefly  fresh 
fish  and  green  vegetables  and  swimming 
daily.  My  experience  can  be  paralleled 
by  many  hay  fever  patients  that  as  long 
as  I  remained  among  the  pines,  I  was  in 
perfect  health  but  on  going  down  into  the 
valley,  one  breath  of  fragrant  wind  blow- 
ing over  the  fields  would  cause  instant  itch- 
ing and  swelling  of  eyes  and  nose  and  all 
the  previous  hygienic  life  up  at  the  lake 
was  no  protection  against  the  disorder.  I 
have  seen  the  hereditary  form  develop  in 
three  children  of  one  family  while  they  were 
at  the  seashore,  bathing  daily  in  salt  water 
and  living  a  care-free,  active,  out-door  life, 
never  taking  tea,  coffee  or  alcohol  and  not 
much  meat. 

So,  I  concluded  long  ago  that  there  must 
be  two  kinds  of  hay  fever,  one  kind  curable 
by  diet,  bathing  and  exercise  and  another 
kind  in  which  habits  of  living  and  eating 


ii6         The  Treatment  of  II ay  Fever 

made  no  difference;   and  I  had  seen  mostly 
the  other  kind. 

Now,  there  may  well  be  cases  of  hay  fever 
as  there  are  known  to  be  cases  of  that  other 
anaphylaxis,  asthma,  that  are  pure  ex- 
amples of  food  anaphylaxis.  In  such  a 
case,  detecting  the  irritating  food  and  re- 
moving it  from  the  diet  is  the  proper  path 
to  cure.  The  error  in  our  former  practice 
was  to  divide  foods  into  good  and  bad  for 
certain  diseases.  We  should  rather  think 
of  foods  as  good  or  bad  for  a  particular 
patient. 

The  plain  people  long  ago  cr>^stallized 
their  experience  in  diet  in  the  maxim  that 
what  is  one  man's  meat  is  another  man's 
poison,  but  your  scientist  will  never  believe 
anything  until  he  sees  it  in  a  test-tube  and 
physicians  have  kept  on  a  few  centuries 
behind  the  rest  of  the  world  prescribing  diet 
for  all  cases  of  the  same  disease  irrespective 
of  whether  or  not  it  agreed  with  the  patient. 
Witness  the  rigid  diets  for  tuberculosis  and 
Bright's  disease.  So,  inevitably,  there  had 
to  be  a  diet  for  hay  fever  and  equally  in- 
evitably, the  same  diet  did  not  agree  with 
everybody. 


Diet  117 

Scientific  men  are  fond  of  stating  in  scien- 
tific terms  what  everybody  else  knows  al- 
ready. While  we  have  known  for  a  long 
time  that  some  foods  did  not  agree  with 
everybody,  science  is  just  now  demonstrat- 
ing that  one  man's  meat  is  literally  another 
man's  poison  by  testing  the  different  food 
proteins  on  the  skin  and  calling  the  condi- 
tion food  anaphylaxis  or  food  allergie. 

As  the  patient  reader  of  the  chapter  on 
Pollens  will  remember,  the  anaphylaxis  or 
sensitiveness  of  the  patient  to  particular 
pollens  is  tested  by  rubbing  a  speck  of  dif- 
ferent pollens  into  scratches  on  the  skin. 
This  skin  reaction  as  a  test  of  anaphylaxis 
was  used  by  Schloss  with  different  foods 
before  it  was  adopted  in  hay  fever;  and  it 
has  been  taken  up  by  the  dermatologist 
also.  The  dermatologist  has  long  suspected 
that  certain  skin  diseases,  as  urticaria,  and 
eczema,  are  aggravated  or  produced  by 
certain  foods  but  he  has  been  unable  to 
demonstrate  just  what  foods  were  at  fault. 
The  problem  was  confused  by  the  fact  that 
he  had  found  no  guiding  principle.  Food 
that  one  patient  could  eat  with  impunity 
brought  out  a  beautiful  eczema  or  urticaria 


ii8         The  Treatment  of  Hay  Fcocr 

on  another  patient.  The  uric  acid  theory 
was  one  effort  to  solve  this  problem  but  it 
was  not  comprehensive  enough  and  it  was 
not  true.  P'orbidding  nitrogenous  foods  has 
been  a  favorite  formula  with  some  and  they 
straightway  advised  milk,  which  is  highly 
nitrogenous.  The  recent  recognition  that 
food  sensitiveness  is  an  anaphylaxis  and  the 
detection  of  the  foods  at  fault  by  the  skin 
reaction  may  supply  the  missing  guiding 
principle  that  was  needed  to  adjust  a  diet 
to  the  individual  needs. 

The  poisonous  element  in  food  is  the 
protein.  The  food  itself  will  serve  for  the 
skin  test  but  it  is  better  to  use  the  pure  food 
protein,  which  gives  clearer  reactions  and 
avoids  contamination.  Proteins  of  all  our 
common  foods  are  now  obtainable  in  the 
drug  trade  put  up  in  tiny  capsules  ready  for 
the  test. 

The  skin  is  cleansed  with  soap  and  water 
and  dried.  A  number  of  little  spots  are 
denuded  of  their  superficial  epithelia  by 
twirling  a  small  brad-awl,  which  should  not 
scrape  deeply  enough  to  draw  blood.  Most 
workers  speak  of  scratching  the  skin  but 
the  brad-awl  scrapes   to   the  j)roper  dc]:)th 


Diet  119 

more  quickly  and  easily.  The  spots  are 
marked  with  the  names  of  the  foods  to  be 
tested,  as  milk,  beef,  potato,  oats,  etc.,  and 
a  drop  of  a  five  per  cent  solution  in  water 
of  the  respective  proteins  is  rubbed  into 
the  spots.  One  spot  is  left  as  a  control, 
into  which  normal  saline  or  3%  solution 
of  milk  sugar  is  rubbed,  as  the  proteins  of 
commerce  are  made  up  with  milk  sugar. 
Within  five  or  ten  minutes,  there  appears  a 
redness  and  swelling,  as  with  the  pollens. 
As  with  the  pollens,  a  patient  who  at  any 
time  has  been  poisoned  or,  as  we  now  say, 
sensitized  by  any  of  these  foods,  still  has 
circulating  in  his  blood  or  fixed  in  his  skin 
the  reactive  bodies  to  that  food.  These 
reaction  bodies  react  to  that  food  on  the  skin 
by  redness  and  swelling.  Food  proteins  that 
cause  no  redness  and  sweUing  are  thought 
harmless  for  that  patient.  Foods  that  cause 
the  reaction  are  thought  to  be  those  to  which 
the  patient  has  been  sensitized  and  to  which 
he  has  not  developed  or  maintained  an 
efficient  defence.  There  is  a  contradiction 
here;  for  the  reaction  merely  shows  the 
presence  of  defense  bodies  in  the  blood  and 
does  not  tell  us  whether  that  defence  is  or 


1 20         The  Treatment  oj  Hay  Fever 

is  not  eflicient.  However,  even  if  the  argu- 
ment limps,  the  results  reported  are  en- 
couraging. Some  striking  cures  have  been 
reported  by  simply  excluding  these  foods 
from  the  diet.  The  test  is  simple  and 
harmless  if  the  scratch  is  not  too  deep  and 
if  the  protein  is  not  injected  beneath  the  skin. 
If  injected  beneath  the  skin  or  rubbed  into 
a  deep  scratch,  the  food  proteins,  like  the 
pollen  proteins,  may  be  dangerous.  If  they 
are  absorbed  rapidly  into  the  circulation 
of  a  patient  who  happens  to  have  been 
sensitized  to  any  of  them,  there  is  serious 
danger  of  anaphylactic  shock. 

If  these  observations  prove  reliable,  here 
is  a  method  of  selecting  a  diet  for  the  in- 
dividual patient  that  surpasses  in  accuracy 
anything  that  we  have  ever  known.  If  hay 
fever  is  ever  a  food  anaphylaxis,  this  method 
of  testing  the  food  sensitiveness  of  the  in- 
dividual patient  promises  much;  but  these 
observations  are  still  too  new  and  uncon- 
firmed and  the  skin  reaction  too  uncertain 
to  rely  on  it  implicitly  yet.  There  was  a 
time,  back  in  1908  to  19 10,  when  the  skin 
reaction  for  tuberculosis  too  was  highly 
valued.     Enthusiasts    proposed    to    test    all 


Diet  121 

the  school  children  and  all  the  soldiers  and 
all  the  factory  workers  and  segregate  the 
tubercular  by  the  skin  test.  The  diagnosis 
of  tuberculosis  was  to  be  put  in  words  of 
one  syllable. 

That  dream  is  over.  Tuberculin  skin 
reactions  have  now  been  made  by  the  mil- 
lion and  we  know  that  a  positive  reaction 
means  nothing  but  that,  at  some  time,  the 
patient  has  been  infected  with  tubercu- 
losis. The  skin  test  does  not  tell  us  whether 
he  has  recovered  long  ago  and  built  up  a 
good  defense  or  whether  he  is  still  sick  with 
tuberculosis  and  will  die  of  it.  It  reacts 
equally  well  in  the  healthy,  vigorous  sub- 
ject who  at  one  time  has  had  a  mild  tuber- 
culosis and  recovered,  in  the  patient  with 
early  phthisis  and  in  the  advanced  case. 
In  Kraus  and  Levaditi's  Handhuch  der 
Technik  und  Methodik  der  Immunitdtslehre, 
1 91 1,  page  205,  von  Pirquet  himself,  the 
grandfather  of  all  the  skin  tests,  says,  "A 
positive  skin  reaction  indicates  with  cer- 
tainty that  the  organism  has  been  infected 
with  tuberculosis.  Of  the  localization,  ex- 
tent and  prognosis  of  tubercular  infection, 
a  positive  skin  reaction  gives  no  conclusion." 


122  The  Treatment  of  II ay  Fever 

Yet  hundreds  of  physicians  to-day  are 
making  diagnoses  of  tuberculosis  by  the 
skin  test;  for  if  there  is  one  thing  more 
difficult  than  to  get  a  new  idea  into  a  doctor's 
head,  it  is  getting  it  out  again  when  the 
idea  proves  fallacious.  So,  I  view  these 
skin  reactions  for  food  and  pollens  with 
some  suspicion  of  their  real  value  in  diag- 
nosis and  prognosis  and  as  guides  to  treat- 
ment. Still,  Talbot  says,  "Experience  has 
shown  that  when  a  positive  skin  test  is 
obtained  for  a  food  and  that  food  is  then 
excluded  from  the  diet,  the  general  condi- 
tion of  the  patient  almost  invariably  im- 
proves and  in  many  instances  a  cure  results." 
!May  his  words  prove  true. 


CHAPTER   XIV 

ROSIN-WEED  AGAIN 
HISTORICAL  AND  PHARMACOLOGICAL 

When  we  wish  to  learn  anything  about 
American  medical  literature,  we  turn  to  the 
big  Index  Catalogue  of  the  Library  of  the 
Surgeon-General.  The  botanical  name  of 
rosin-weed  is  silphium.  In  the  Index  Cata- 
logue, the  word  rosin-weed  does  not  appear, 
but,  in  the  first  series,  under  silphium, 
there  are  ten  references,  and  thereby  hangs 
a  tale. 

Ancient  Silphium.  In  ancient  Greek  and 
Roman  medicine  there  was  a  famous  gum 
called  silphion  (Latin  silphium)  which,  like 
aU  popular  medicines,  was  the  better  for 
being  brought  from  a  far  country  and  for 
being  a  little  mysterious;  for  it  was  brought 
across  the  Mediterranean  from  Cyrene, 
where  it  had  been  originally  presented  to 
the  inhabitants  of  that  favored  place  by 
the  gods.  Learned  botanists  have  discussed 
at  length  what  plant  produced  this  gum  and 
have  concluded  that,  like  its  neighbor  in 
Egypt,  the  papyrus  plant,  it  has  disappeared 


124         The  Treatment  of  Hay  Fever 

from  the  earth.  Even  in  Dioscorides'  time 
the  plant  was  getting  scarce  and  there  came 
a  day  when  in  all  Cyrene  there  remained 
only  a  single  silphium  plant,  which  was 
piously  presented  to  that  worthy  repre- 
sentative of  the  gods,  the  emperor  Nero. 

In  the  year  1 817,  an  Italian,  Delia  Cclla, 
returning  from  an  expedition  of  the  Eg}'p- 
tian  Pasha  against  the  neighboring  Arab 
tribes,  reported  that  he  had  discovered  the 
ancient  silphion  growing  on  the  site  of  old 
Cyrene.  He  brought  back  specimens  of 
the  plant  which  were  identified  as  a  species 
of  thapsia.  Several  expeditions  brought 
back  more  specimens  but  there  was  little 
general  interest  until  Laval,  in  1859,  saw  the 
commercial  possibilities  in  a  revival  of  this 
wonder-medicine  and  put  the  famous  old 
cure-all  on  the  market  as  a  specific  for  con- 
sumption, under  the  name  of  silphium 
Cyrenaicum,  backed  by  the  endorsement  of 
all  the  ancients  from  Hippocrates  to  Pliny. 
Seldom  has  even  a  French  or  German  drug 
house  found  so  distinguished  a  company  of 
medical  authorities  to  endorse  its  wares. 
Whereat,  there  began  a  brisk  discussion  in 
the   European  journals,   first,   whether  the 


Rosin-Weed  Again  125 

ancient  silphion  had  been  found  and,  sec- 
ondly, whether,  if  found,  it  was  worth 
anything.  Both  questions  being  finally  de- 
cided in  the  negative,  the  ancient  silphion 
passes  again  into  the  twilight  of  tradition ; 
all  of  which  entertaining  tale  may  be  read 
at  great  length  in  the  Dictionnaire  En- 
cyclop  cedique  des  Sciences  Medicates,  Paris, 
1 88 1,  Volume  9. 

Now,  with  one  exception,  all  the  refer- 
ences to  silphium  in  the  Index  Catalogue 
refer  to  this  silphion  controversy  and  have 
nothing  to  do  with  our  American  silphium 
or  rosin-weed.  The  exception  is  the  refer- 
ence to  Dr.  Goss,  to  be  related  presently. 

The  American  Silphium.  On  the  Ameri- 
can prairies  from  Ohio  south  and  west  to 
Texas,  as  far  north  as  Wisconsin  and  south 
to  Florida,  there  grows  abundantly  a  plant 
unknown  in  Europe  and  better  known  here 
to  botanists  than  to  physicians.  From  the 
gummy  juice  that  exudes  from  the  leaves 
and  stem,  Linnaeus  himself  named  the 
genus  silphium  in  memory  of  the  ancient 
silphion  of  Cyrene  and  the  plain  people 
called  it  rosin-weed.  There  are  more  than 
twenty  species  of  rosin-weed  or  silphium,  all 


126         The  Treatment  of  Hay  Fever 

probably  similar  in  their  medicinal  virtues. 
The  species  that  we  have  used  in  hay  fever 
is  the  silphiiim  laciniatum  {Silphium  ginn- 
miferum,  Ell.)  This  species  is  known  also 
as  the  compass-plant  or  pilot-weed  because 
the  large  lower  leaves  present  their  faces 
north  and  south,  as  we  may  remember  from 
our  boyhood  tales  of  the  plains  where  the 
trapper  never  lost  his  way  because  he  had 
simply  to  look  down  at  his  feet  and  there 
was  the  compass-plant  pointing  faithfully 
to  the  north. 

Rosin -Weed  among  the  Indians.  This 
rosin-weed  is  not  a  poisonous  plant.  Chil- 
dren all  over  the  west  gather  the  resin  for 
chewing-gum  as  the  Indians  did  before 
them  and  horses  eat  it  freely,  being  thereby 
protected  from  the  heaves,  as  the  frontier 
tradition  goes.  Rosin-weed  was  valued 
highly  by  the  Indian.  He  chewed  the  gum 
to  make  his  breath  sweet  and  drank  a  de- 
coction of  the  root  to  make  him  live  forever. 
The  rosin-weed  of  the  Indian  is  the  parallel 
of  the  ancient  silphion,  the  opoponax  or 
all-healing  juice  of  southern  Europe,  the 
spruce  gum  and  pine  tar  of  rural  America 
and    the   more   valued   resins   of   the   East 


Rosin-Weed  Again  127 

where,  in  Othello's  time,  the  trees  dropped 
down  their  medicinal  gum;  for  we  find  the 
native  gums  used  all  over  the  world  for 
the  same  diseases,  cough  and  consumption 
and  urinary  distress,  always  with  a  dash 
of  mystery  and  the  idea  of  prolonging  life. 

Rosin-Weed  among  the  Eclectics.  One 
would  have  thought  that  the  early  American 
botanic  physicians  who  worked  so  indus- 
triously to  introduce  American  plants  and 
who  learned  the  use  of  many  native  plants 
from  the  Indians,  would  have  adopted  such 
a  popular  remedy  but  I  find  no  mention  of  it 
in  their  books.  The  learned  writer  in  the 
Dictionnaire  des  Sciences  Medicates  was  cor- 
rect in  writing,  in  1821,  Volume  51,  page 
312,  that  there  were  several  varieties  of 
silphium,  all  growing  in  America,  but  that 
none  of  them  as  yet  had  been  used  as 
medicines. 

It  was  reserved  for  a  successor  of  the  old 
botanic  school,  an  eclectic  physician,  Dr. 
H.  B.  Garrison,  to  introduce  rosin-weed 
into  medical  practice  as  a  specific  for 
asthma  in  an  article  in  the  Eclectic  Medical 
Review  in  1868.  This  article  was  abstracted 
in  the  Pacific  Medical  and  Surgical  Journal, 


128         The  Treatment  of  Hay  Fever 

in  the  Nashville  Joiirywl  of  Medicine  and 
Surgery  and  in  P>ancis  Porcher's  Medical 
Botany  of  the  Southern  States,  second  edi- 
tion, 1869  (not  in  the  first  edition  of  1863). 
Dr.  Garrison  noted  also  the  popular  belief 
that  heaves  or  asthma  did  not  exist  in  horses 
on  the  prairies  where  this  plant  grew. 

For  a  few  years,  rosin-weed  became  popu- 
lar and  was  widely  commented  on  in  the 
eclectic  journals ;  but  it  soon  dropped  out  of 
sight  and  is  not  to  be  found  in  any  eclectic 
text  books  to-day. 

Rosin-Weed  among  the  Homoeopaths. 
Rosin-weed  comes  into  the  homoeopathic 
school  through  ''  the  indefatigable  Dr.  Hale," 
as  Richard  Hughes  calls  him.  The  homoeo- 
pathic school  owes  much  to  Dr.  E.  M.  Hale, 
who  enriched  our  materia  medica  with  many 
American  plants,  most  of  them  drawn  from 
the  eclectic  school  and,  be  it  noted.  Dr. 
Hale  gives  full  credit  to  that  school  from 
which  the  new  medicines  came.  Dr.  Hale 
did  masterly  work  in  proving  the  new 
remedies  and  verifying  the  observations  of 
the  eclectic  physicians  and  published  his 
Characteristics  of  New  Remedies  in  1864. 
In  1868,  Dr.  Garrison  published  his  paper 


Rosin-Weed  Again  129 

on  the  use  of  rosin-weed  in  asthma  and  Dr. 
Hale,  in  his  third  edition  of  1873,  included 
rosin-weed  under  the  name  silphium  lacin- 
iatum,  as  follows: 

SILPHIUM    LACINIATUM 

ROSIN-WEED 

Syn.  (page  544)  Compass-plant,  Polar-plant, 
Rosin-weed. 

Analogues,  Cubeba,  Copaiva,  Terebinthina. 

Officinal  preparations.  —  Tincture  of  leaves  : 
dilutions. 

Catarrhal  affections  and  diseases  of  the  mucous 
membranes. — Eclectic. 

Chronic  catarrh  of  the  nasal  passages. 

Chronic  laryngitis  and  bronchitis. 

Asthma,  hurried  (breathing  ?)  with  concomitant 
catarrhal  affections  of  the  bronchial  mucous  sur- 
faces. 

(It  is  a  popular  domestic  remedy  in  asthma. 
Eclectic  physicians  value  it  highly  in  throat  affec- 
tions. Some  homoeopathic  physicians,  Drs.  Small, 
Kendall  and  others  have  used  it  with  gratifying 
results.  —  Hale.) 

Horses  that  eat  of  the  leaves  mixed  in  hay  are 
cured  or  relieved  of  the  heaves  and  chronic  loose 
cough. 

Catarrh  of  the  bladder. 

Dr.  Hale  did  not  prove  this  remedy.  All 
symptoms  except  the  last  one  are  clinical, 


130         The  Treatment  oj  II ay  Fever 

that  is,  they  disappeared  while  the  patient 
was  taking  the  remedy  but  they  have  not 
been  produced  on  the  healthy.  The  last 
symptom  is  a  pathogenetic  symptom  verified 
by  cure.  There  is,  however,  a  proving  of 
silphium  but  it  is  buried  deep  in  the  dust  that 
covers  old  reports  and  has  not  seen  the 
light  of  day  for  many  a  year.  I  reprint 
it  here  from  the  Ilahncmannian  Monthly^ 
Volume  8,  June,  1873,  page  536,  from  the 
report  of  a  meeting  of  the  Philadelphia 
County  Homoeopathic  Society. 

"Silphium  lac— Dr.  G.  A.  Hall,  in  the  April 
number  of  the  Medical  Investigator  gives  a  sum- 
mary of  a  proving.  (The  first  decimal  trituration 
was  given  in  doses  of  two  grains  gradually  in- 
creased to  ten  grains  every  two  hours.) 

"It  produces  a  scraping,  tickling  and  irritation 
of  the  fauces  and  throat;  nausea,  sick,  faint  feel- 
ing and  a  sense  of  goneness  in  the  epigastrium;  a 
desire  to  hawk  and  scrape  the  throat,  throwing 
off  a  thin  viscid  mucus.  The  irritation  extends 
up  the  posterior  nares,  involving  the  mucous 
membrane  of  the  nasal  passages,  producing  sneez- 
ing, followed  by  a  discharge  of  limpid,  acrid 
mucus  from  the  nose,  attended  with  constriction 
and  pressure  in  the  supra-orbital  region.  Engorge- 
ment and  thickening  of  the  mucous  membrane  of 
the  throat  as  far  down  as  could  be  seen;  rough 


Rosin-Weed  Again  131 

cough,  attended  with  the  expectoration  of  yellow 
mucus;  contraction  and  tightness  of  lungs,  constant 
disposition  to  raise;  hacking,  spasmodic  cough; 
tongue  covered  with  whitish  slimy  coat  attended 
with  dry  sensation  as  if  burned  with  hot  soup; 
urine  high  colored  and  scant,  frequent  passages 
with  sense  of  heat  at  the  meatus  urinarius  during 
passage  of  urine ;  stools  natural  in  form  but 
covered  with  whitish,  slimy  mucus.  An  internal 
feverish  sensation;  pulse  not  accelerated;  want  of 
appetite. 

"  Clinical  Observation.  For  ten  years,  I  have 
used  silphium  in  asthma  with  large  quantities  of 
stringy  mucus,  in  influenza,  coryza,  catarrh,  and 
beUeve  it  to  be  the  best  remedy  we  have  in  phthi- 
sis when  gray  or  yellow  mucus  is  expectorated 
copiously,  causing  rapid  exhaustion.  I  use  the 
second  decimal  trituration  in  one  or  two-grain 
doses  every  two  hours  until  expectoration  is  dimin- 
ished perceptibly  and  then  at  intervals  of  four  or  six 
hours  until  expectoration  is  diminished  to  a  degree 
consistent  with  other  symptoms  of  the  case." 

In  spite  of  this  good  start,  rosin-v^eed  did 
not  have  any  better  fortune  with  the 
homoeopaths  than  vi^ith  the  eclectics.  It 
never  got  into  the  text  books.  After  tran- 
sient popularity  in  the  journals,  it  sank 
back  into  obscurity  and  has  remained  as 
a  remedy  for  asthma  in  the  memory  of  a 


132  The  Treatment  of  Hay  Fever 

few  of  the  older  practitioners  from  whom  it 
is  occasionally  handed  on  by  oral  tradition. 

It  was  in  1872  when  rosin-weed  was  enjoy- 
ing its  brief  publicity  and  when  the  epi- 
demic of  epizootic  among  the  horses  created 
a  public  interest  in  veterinary  medicines, 
that  my  father,  Dr.  Alexander  H.  Laidlaw, 
discovered  its  remarkable  curative  power  in 
hay  fever,  as  related  in  Chapter  II. 

Rosin-Weed  among  the  "Allopaths." 
Rosin-weed  never  got  into  the  Pharma- 
copoeia but  it  is  none  the  worse  for  that. 
More  people  have  been  poisoned  by  the 
drugs  inside  of  the  Pharmacopoeia  than  by 
those  outside  of  it.  Except  the  few  com- 
ments by  western  and  southern  medical 
journals,  it  was  practically  unknown  in  the 
dominant  school,  as  shown  by  there  being 
only  one  reference  to  it  in  the  Index  Cata- 
logue. This  is  an  article  by  Dr.  Q.  J.  M. 
Goss,  of  Marietta,  Georgia,  in  the  Nashville 
Journal  of  Medicine^  1887,  xx,  page  60,  in 
which  Dr.  Goss  praises  rosin-weed  highly 
for  its  power  to  cure  catarrh  of  the  mucous 
membranes,  comparing  it  to  the  balsams, 
cubeb  and  turpentine,  and  relating  the  cure 
of  two  cases  of  asthma. 


Rosin-Weed  Again  133 

In  the  Library  of  the  New  York  Academy 
of  Medicine,  there  is  a  thin  pamphlet  by 
Dr.  Goss,  entitled  New  Medicines,  which 
I  suspect  to  be  taken  chiefly  from  Dr. 
Hale's  New  Remedies,  in  which  he  says  of 
silphium  laciniatum,  "It  has  proved  for  me 
one  of  the  best  remedies  in  humid  asthma. 
I  have  made  several  brilliant  cures  with 
the  tincture  of  this  plant  and  the  tincture 
of  ptelea  trifoliata  in  doses  of  30  drops  each 
four  times  a  day  in  simple  elixir.  ...  In 
acute  diseases  of  the  mucous  membranes, 
the  dose  should  be  small,  5  to  10  drops; 
but  in  chronic  inflammation,  the  dose  may 
be  30  drops  of  the  saturated  tincture.  It 
is  a  valuable  remedy  in  chronic  bronchitis 
and  tracheitis.  It  will  soon  become  a  popu- 
lar remedy  in  mucous  diseases." 

This  prophecy  of  popularity  was  scarcely 
borne  out;  for,  with  the  exception  of  the 
article  by  him  in  1887,  rosin-weed  drops 
out  of  sight  and  is  found  in  no  books  pub- 
lished in  the  last  forty  years. 

Pharmacology.  For  the  following  infor- 
mation, I  am  indebted  to  the  Botanical  De- 
partment of  Parke,  Davis  &  Co.,  whom  I 
wish  to  thank  for  their  unfaiHng  courtesy 


134         The  Treatment  oj  Hay  Fever 

in  replying  to  my  inquiries  about  this  little 
known  plant: 

"Rosin  weed  is  a  general  name  for  all  species  of 
the  genus  silphium  of  which  there  are  more  than 
twenty  species;  some  of  these  species,  however, 
have  special  names.  Three  species  are  usually 
mentioned  as  being  used  for  medicinal  purpose. 
We  list  them  with  their  synonyms  as  follows: 

Silphium  perfoliatum,  Lin.  Indian  cup,  ragged 
cup,  cup  plant,  rosin  weed. 

Silphium  terebinthinaceum,  Lin.  rosin  weed 
(true),  prairie  dock. 

Silphium  laciniatum,  Lin.  Syn.  S.  gummiferum, 
Ell.  compass-plant,  polar  plant,  pilot  jilant,  rosin 
weed. 

It  is  more  than  probable  that  all  the  species 
of  the  genus  are  equally  effective  from  a  thera- 
peutic point  of  view." 

We  have  always  used  the  fluid  extract 
of  the  herb.  Goss  and  Hale  used  the  tinc- 
ture of  the  fresh  leaves  and  so  the  homoeo- 
paths have  always  used  it.  Since  looking 
into  the  histor>'  of  the  plant,  I  recall  a 
remark  of  that  wise  old  physician,  Rade- 
macher,  in  regard  to  chelidonium.  Ich  bin 
kcin  Freund  von  Extraktcn.  He  preferred 
the  tincture  of  the  fresh  plant.  Tinctures 
of  the  fresh  plant  were  Hahnemann's  pref- 
erence  too,  and   it   may  well   be  that  with 


Rosin-Weed  Again  135 

rosin-weed  also,  the  tincture  preserves  the 
medicinal  power  better  than  the  extract. 

Mode  of  Action.  If  the  proving  of  rosin- 
weed  made  by  Dr.  Hall  is  reliable,  we  must 
conclude  that  rosin-weed  cures  the  symp- 
toms that  it  produces  in  the  healthy  and 
it  must  be  regarded  as  acting  on  the  homoeo- 
pathic principle.  I  must  own  that  I  am 
a  little  suspicious  of  provings  that  match  so 
closely  the  long  established  popular  use  of 
a  drug  and,  in  this  case,  believe  that  we 
must  wait  for  confirmation  of  this  proving 
before  accepting  it  as  sound.  Rosin-weed 
has  always  seemed  to  me  to  be  a  harmless 
herb,  which  is  shown  also  by  its  use  among 
children  as  chewing  gum.  I  have  never 
noticed  the  "tonic,  diaphoretic  or  diuretic 
effects"  attributed  to  it  in  eclectic  medicine 
and  believe  that  they  must  be  feeble.  The 
only  unpleasant  effect  that  I  have  noted  is 
nausea  after  large  doses,  sixty  drops  or  more, 
and  this  in  very  few  patients.  Vomiting 
is  rare,  is  never  serious  and  ceases  spon- 
taneously when  the  stomach  is  empty  of 
the  drug. 

At  the  Baltimore  meeting  of  the  American 
Institute  of  Homoeopathy,  where  the  use  of 


136  The  Trealnient  of  Hay  Fever 

rosin-weed  in  hay  fever  was  first  reported, 
Dr.  John  Sutherland,  of  Boston,  made  the 
proper  criticism  that  if  rosin-weed  was  harm- 
less and  could  not  produce  any  effect  on  the 
healthy  body,  he  could  not  understand  how 
it  had  any  power  to  cure.  To  this,  I  had 
no  answer  except  that  I  had  both  taken 
and  given  large  doses  for  many  years  to 
patients  of  all  ages  and  had  never  seen  any 
symptoms  develop.  Another  speaker  sug- 
gested that,  like  calcarea  and  silica,  poten- 
tization  would  develop  pathogenetic  powers 
that  were  not  evident  in  the  crude  drug. 
This  I  have  never  tried.  As  related  in  the 
chapter  on  Bacterial  Vaccines,  I  suspect  that 
the  curative  power  of  rosin-weed  in  hay  fever 
lies  in  its  power  of  relieving  a  coexisting 
catarrh,  of  which  theory  we  have  the  confirm- 
ing evidence  that  other  methods  that  cure 
catarrh,  nasal  operations,  bacterial  vaccines, 
homoeopathic  remedies,  have  often  cured  a 
coexisting  hay  fever.  Since  that  discussion,  I 
have  found  Dr.  Hall's  proving.  It  would  be 
a  pleasure  to  find  that  our  old  family  remedy 
for  hay  fever  really  acts  on  the  homoeopathic 
principle  but  I  believe  that  the  question 
needs  the  verification  of  further  proving. 


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